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Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events.
Circulation. 2006 Mar 28; 113(12):1578-87.Circ

Abstract

BACKGROUND

Although randomized trials of cyclooxygenase-2 (COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent.

METHODS AND RESULTS

We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in a prospective cohort of 70,971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1 to 21 d/mo) use of NSAIDs or acetaminophen did not experience a significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (> or =22 d/mo) used NSAIDs had a relative risk (RR) for a cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had a RR of 1.35 (95% CI, 1.14 to 1.59). The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR=1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction=0.02). Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for a cardiovascular event among women who used > or =15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen.

CONCLUSIONS

Use of NSAIDs or acetaminophen at high frequency or dose is associated with a significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk.

Authors+Show Affiliations

Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. achan@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16534006

Citation

Chan, Andrew T., et al. "Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events." Circulation, vol. 113, no. 12, 2006, pp. 1578-87.
Chan AT, Manson JE, Albert CM, et al. Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events. Circulation. 2006;113(12):1578-87.
Chan, A. T., Manson, J. E., Albert, C. M., Chae, C. U., Rexrode, K. M., Curhan, G. C., Rimm, E. B., Willett, W. C., & Fuchs, C. S. (2006). Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events. Circulation, 113(12), 1578-87.
Chan AT, et al. Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events. Circulation. 2006 Mar 28;113(12):1578-87. PubMed PMID: 16534006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events. AU - Chan,Andrew T, AU - Manson,JoAnn E, AU - Albert,Christine M, AU - Chae,Claudia U, AU - Rexrode,Kathryn M, AU - Curhan,Gary C, AU - Rimm,Eric B, AU - Willett,Walter C, AU - Fuchs,Charles S, Y1 - 2006/03/13/ PY - 2006/3/15/pubmed PY - 2006/4/15/medline PY - 2006/3/15/entrez SP - 1578 EP - 87 JF - Circulation JO - Circulation VL - 113 IS - 12 N2 - BACKGROUND: Although randomized trials of cyclooxygenase-2 (COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent. METHODS AND RESULTS: We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in a prospective cohort of 70,971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1 to 21 d/mo) use of NSAIDs or acetaminophen did not experience a significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (> or =22 d/mo) used NSAIDs had a relative risk (RR) for a cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had a RR of 1.35 (95% CI, 1.14 to 1.59). The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR=1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction=0.02). Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for a cardiovascular event among women who used > or =15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen. CONCLUSIONS: Use of NSAIDs or acetaminophen at high frequency or dose is associated with a significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/16534006/Nonsteroidal_antiinflammatory_drugs_acetaminophen_and_the_risk_of_cardiovascular_events_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.595793?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -