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Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease

      Abstract

      Background

      There is limited information about the safety of chronic nonsteroidal anti-inflammatory drugs (NSAIDs) in hypertensive patients with coronary artery disease.

      Methods

      This was a post hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST), which enrolled patients with hypertension and coronary artery disease. At each visit, patients were asked by the local site investigator if they were currently taking NSAIDs. Patients who reported NSAID use at every visit were defined as chronic NSAID users, while all others (occasional or never users) were defined as nonchronic NSAID users. The primary composite outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Cox regression was used to construct a multivariate analysis for the primary outcome.

      Results

      There were 882 chronic NSAID users and 21,694 nonchronic NSAID users (n = 14,408 for never users and n=7286 for intermittent users). At a mean follow-up of 2.7 years, the primary outcome occurred at a rate of 4.4 events per 100 patient-years in the chronic NSAID group, versus 3.7 events per 100 patient-years in the nonchronic NSAID group (adjusted hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.19-1.82; P=.0003). This was due to an increase in cardiovascular mortality (adjusted HR 2.26; 95% CI, 1.70-3.01; P<.0001).

      Conclusion

      Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up.

      Keywords

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      Linked Article

      • Aspirin and the Harmful Effect of NSAIDs
        The American Journal of MedicineVol. 125Issue 2
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          The article by Bavry et al1 reporting the recurrence of myocardial infarction after the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with established cardiovascular disease is of great interest and of relevance for clinicians working in the “real world.” Although the mechanism for the harmful effect of NSAIDs remains poorly understood, it is feasible that NSAIDs would induce an imbalance between cyclooxygenase-2 (COX-2)-derived prostacyclin (PGI2) and the COX-1-derived thromboxane (TXA2).
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