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The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin.
J Am Coll Cardiol. 2004 Mar 17; 43(6):985-90.JACC

Abstract

OBJECTIVES

This study was designed to determine if non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) are associated with lower odds of myocardial infarction (MI) and if NANSAIDs, particularly ibuprofen, interfere with aspirin's cardioprotective effect.

BACKGROUND

The NANSAIDs may reduce the risk of MI but may also interfere with aspirin's cardioprotective effect.

METHODS

A case-control study was conducted, with cases of first, nonfatal MI identified prospectively and controls identified randomly from the community.

RESULTS

The use of NANSAIDs was associated with a significant reduction in MI among those not using aspirin (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.42 to 0.67). This was true for both ibuprofen (adjusted OR 0.52; 95% CI: 0.39 to 0.69) and naproxen (adjusted OR 0.48; 95% CI: 0.28 to 0.82). Although aspirin itself was associated with decreased odds of MI in those not also using NANSAIDs (adjusted OR relative to no aspirin use 0.79; 95% CI: 0.63 to 0.98), it was not associated with decreased odds of MI among those who were using NANSAIDs (OR 1.28; 95% CI: 0.85 to 1.94; p value for interaction = 0.026). The association of aspirin and reduced odds of MI diminished with increasing frequency of NANSAID use (test for interaction p = 0.006), particularly for ibuprofen (p = 0.018). Among frequent (4 times/week) NANSAID users, the OR for aspirin versus no aspirin was 2.04 (95% CI: 1.06 to 3.94). Users of prophylactic aspirin plus frequent ibuprofen had an OR relative to aspirin-only users of 2.03 (95% CI: 0.60 to 6.84).

CONCLUSIONS

In the absence of aspirin use, NANSAIDs are associated with reduced odds of MI. In those using aspirin, NANSAIDs do not provide additional protection. Additional study is needed to determine the clinical impact of using NANSAIDs along with aspirin for cardioprotection.

Authors+Show Affiliations

Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. skimmel@cceb.med.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15028354

Citation

Kimmel, Stephen E., et al. "The Effects of Nonselective Non-aspirin Non-steroidal Anti-inflammatory Medications On the Risk of Nonfatal Myocardial Infarction and Their Interaction With Aspirin." Journal of the American College of Cardiology, vol. 43, no. 6, 2004, pp. 985-90.
Kimmel SE, Berlin JA, Reilly M, et al. The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin. J Am Coll Cardiol. 2004;43(6):985-90.
Kimmel, S. E., Berlin, J. A., Reilly, M., Jaskowiak, J., Kishel, L., Chittams, J., & Strom, B. L. (2004). The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin. Journal of the American College of Cardiology, 43(6), 985-90.
Kimmel SE, et al. The Effects of Nonselective Non-aspirin Non-steroidal Anti-inflammatory Medications On the Risk of Nonfatal Myocardial Infarction and Their Interaction With Aspirin. J Am Coll Cardiol. 2004 Mar 17;43(6):985-90. PubMed PMID: 15028354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of nonselective non-aspirin non-steroidal anti-inflammatory medications on the risk of nonfatal myocardial infarction and their interaction with aspirin. AU - Kimmel,Stephen E, AU - Berlin,Jesse A, AU - Reilly,Muredach, AU - Jaskowiak,Jane, AU - Kishel,Lori, AU - Chittams,Jesse, AU - Strom,Brian L, PY - 2003/04/16/received PY - 2003/08/11/revised PY - 2003/08/19/accepted PY - 2004/3/19/pubmed PY - 2004/4/7/medline PY - 2004/3/19/entrez SP - 985 EP - 90 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 43 IS - 6 N2 - OBJECTIVES: This study was designed to determine if non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) are associated with lower odds of myocardial infarction (MI) and if NANSAIDs, particularly ibuprofen, interfere with aspirin's cardioprotective effect. BACKGROUND: The NANSAIDs may reduce the risk of MI but may also interfere with aspirin's cardioprotective effect. METHODS: A case-control study was conducted, with cases of first, nonfatal MI identified prospectively and controls identified randomly from the community. RESULTS: The use of NANSAIDs was associated with a significant reduction in MI among those not using aspirin (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.42 to 0.67). This was true for both ibuprofen (adjusted OR 0.52; 95% CI: 0.39 to 0.69) and naproxen (adjusted OR 0.48; 95% CI: 0.28 to 0.82). Although aspirin itself was associated with decreased odds of MI in those not also using NANSAIDs (adjusted OR relative to no aspirin use 0.79; 95% CI: 0.63 to 0.98), it was not associated with decreased odds of MI among those who were using NANSAIDs (OR 1.28; 95% CI: 0.85 to 1.94; p value for interaction = 0.026). The association of aspirin and reduced odds of MI diminished with increasing frequency of NANSAID use (test for interaction p = 0.006), particularly for ibuprofen (p = 0.018). Among frequent (4 times/week) NANSAID users, the OR for aspirin versus no aspirin was 2.04 (95% CI: 1.06 to 3.94). Users of prophylactic aspirin plus frequent ibuprofen had an OR relative to aspirin-only users of 2.03 (95% CI: 0.60 to 6.84). CONCLUSIONS: In the absence of aspirin use, NANSAIDs are associated with reduced odds of MI. In those using aspirin, NANSAIDs do not provide additional protection. Additional study is needed to determine the clinical impact of using NANSAIDs along with aspirin for cardioprotection. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15028354/The_effects_of_nonselective_non_aspirin_non_steroidal_anti_inflammatory_medications_on_the_risk_of_nonfatal_myocardial_infarction_and_their_interaction_with_aspirin_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109703017273 DB - PRIME DP - Unbound Medicine ER -