cox-2抑制剂在心血管疾病中应用.pptVIP

Analgesics among most frequently prescibed to those over 65. Of top forty most commonly used meds in America, analgesics weigh in at first 3. Naproxen was #12. OTC analgesics, while widely-used are used and easy to obtain are under-reported to healthcare providers so if these interactions prove to be clinically significant, patient education will be important about risks of use of NSAIDs for those on ASA. Among 200 patients at the Mayo clinic, almost half, (Hensrud Mayo Clon Proc 1999) and among 200 patients in a family practice setting, about one-third (Eliason, JABFP 1996) did not report OTC medication use to their healthcare provider. * * Kurth paper: 5-year randomized, double-blind, placebo-controlled trial of 325 mg aspirin on alternate days among 22 071 apparently healthy US male physicians with prospective observational data on use of NSAIDs. A total of 378 MIs were confirmed, 139 in the aspirin group and 239 in the placebo group. Aspirin conferred a statistical extreme (P0.00001) 44% reduction in risk of first MI (RR 0.56; 95% CI, 0.45 to 0.70). Among participants randomized to aspirin, use of NSAIDs on 1 to 59 d/y was not associated with MI (multivariable adjusted relative risk [RR], 1.21; 95% confidence interval [CI], 0.78 to 1.87), whereas the use of NSAIDs on =60 d/y was associated with MI (RR 2.86; 95% CI, 1.25 to 6.56) compared with no use of NSAIDs. In the placebo group, the RRs for MI across the same categories of NSAID use were 1.14 (95% CI, 0.81 to 1.60) and 0.21 (95% CI, 0.03 to 1.48). Multivariable regression model controlled for age (in 5-year increments), history of arthritis at baseline, exercise (1 time/mo, 1 time/mo to 4 times/wk, =5 times/wk), body mass index (continuous), history of smoking (never, past, current), and randomized ?-carotene assignment. A second multivariable model controlling for other major risk factors for MI, including baseline information on history of hypertension (defined as self-reported systolic blood pressure