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NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease.

Publication ,  Journal Article
Kohli, P; Steg, PG; Cannon, CP; Smith, SC; Eagle, KA; Ohman, EM; Alberts, MJ; Hoffman, E; Guo, J; Simon, T; Sorbets, E; Goto, S; Bhatt, DL ...
Published in: Am J Med
January 2014

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease. METHODS: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of interest included multivariate adjusted: cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations; cardiovascular death/myocardial infarction/stroke; hospitalization for heart failure; and individual components of the composite end points. RESULTS: Compared with NSAID nonusers (n = 39,675), NSAID users (n = 4420) were older (70 vs 68 years), more frequently female and white, and had more baseline heart failure and atherosclerotic risk factors (hypertension, dyslipidemia, diabetes, reduced creatinine clearance) (all P < .001). NSAID use was associated with an increased hazard for cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations (adjusted hazard ratio [adj. HR] 1.12; 95% confidence interval [CI], 1.04-1.21; P = .003) and for cardiovascular death/myocardial infarction/stroke (adj. HR 1.16; 95% CI, 1.03-1.30; P = .02). There also was a higher risk of myocardial infarction (adj. HR 1.37; 95% CI, 1.12-1.68; P = .002), stroke (adj. HR 1.21; 95% CI, 1.00-1.45; P = .048), heart failure hospitalizations (adj. HR 1.18; 95% CI, 1.03-1.34; P = .013), and ischemic hospitalizations (adj. HR 1.17; 95% CI, 1.07-1.27; P = .001). CONCLUSION: Among patients with stable atherothrombosis, NSAID use is associated with a higher risk of myocardial infarction, stroke, and hospitalizations for both ischemia and heart failure.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

January 2014

Volume

127

Issue

1

Start / End Page

53 / 60.e1

Location

United States

Related Subject Headings

  • Thrombosis
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Outpatients
  • Odds Ratio
  • Myocardial Ischemia
  • Myocardial Infarction
 

Citation

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Kohli, P., Steg, P. G., Cannon, C. P., Smith, S. C., Eagle, K. A., Ohman, E. M., … REACH Registry Investigators, . (2014). NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. Am J Med, 127(1), 53-60.e1. https://doi.org/10.1016/j.amjmed.2013.08.017
Kohli, Payal, Ph Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E Magnus Ohman, Mark J. Alberts, et al. “NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease.Am J Med 127, no. 1 (January 2014): 53-60.e1. https://doi.org/10.1016/j.amjmed.2013.08.017.
Kohli P, Steg PG, Cannon CP, Smith SC, Eagle KA, Ohman EM, et al. NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. Am J Med. 2014 Jan;127(1):53-60.e1.
Kohli, Payal, et al. “NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease.Am J Med, vol. 127, no. 1, Jan. 2014, pp. 53-60.e1. Pubmed, doi:10.1016/j.amjmed.2013.08.017.
Kohli P, Steg PG, Cannon CP, Smith SC, Eagle KA, Ohman EM, Alberts MJ, Hoffman E, Guo J, Simon T, Sorbets E, Goto S, Bhatt DL, REACH Registry Investigators. NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. Am J Med. 2014 Jan;127(1):53-60.e1.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

January 2014

Volume

127

Issue

1

Start / End Page

53 / 60.e1

Location

United States

Related Subject Headings

  • Thrombosis
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Outpatients
  • Odds Ratio
  • Myocardial Ischemia
  • Myocardial Infarction