Background-The selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk, but the risk in patients with established cardiovascular disease is unknown. We analyzed the risk of rehospitalization for acute myocardial infarction (MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with prior MI. Methods and Results-All patients with first-time MI between 1995 and 2002 as well as all prescription claims for NSAIDs after discharge were identified from nationwide Danish administrative registers. The risk of death and rehospitalization for MI associated with the use of selective COX-2 inhibitors and nonselective NSAIDs was studied with the use of multivariable proportional hazards models and case-crossover analysis. A total of 58 432 patients were discharged alive and included in the study; 9773 experienced rehospitalization for MI, and 16 573 died. A total of 5.2% of patients received rofecoxib, 4.3% celecoxib, 17.5% ibuprofen, 10.6% diclofenac, and 12.7% other NSAIDs. For any use of rofecoxib, celecoxib, ibuprofen, diclofenac, and other NSAIDs, the hazard ratios and 95% confidence intervals for death were 2.80 (2.41 to 3.25; for rofecoxib), 2.57 (2.15 to 3.08; for celecoxib), 1.50 (1.36 to 1.67; for ibuprofen), 2.40 (2.09 to 2.80; for diclofenac), and 1.29 (1.16 to 1.43; for other NSAIDS); there were dose-related increases in risk of death for all of the drugs. There were trends for increased risk of rehospitalization for MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs. Conclusions-Selective COX-2 inhibitors in all dosages and nonselective NSAIDs in high dosages increase mortality in patients with previous MI and should therefore be used with particular caution in these patients.
The main problem with underuse of recommended treatment after AMI is that treatment is not initiated at an appropriate dosage shortly after AMI. A focused effort in the immediate post-infarction period would appear to provide long-term benefit.
Chronic obstructive pulmonary disease has been associated with a high frequency of arrhythmias. Few studies have analysed the role of reduced lung function in predicting atrial fibrillation (AF). The aim of the present study was to investigate the relationship between forced expiratory volume in one second (FEV1) and risk of first episode of AF in a prospective study.Data from 13,430 males and females without previous myocardial infarction, who participated in the Copenhagen City Heart Study, were analysed. New AF was assessed at re-examination after 5 yrs and by hospital admission for AF during a period of 13 yrs. Multivariate analyses were used with adjustment for cardiopulmonary risk factors. There were 62 new cases of AF at 5-yr follow-up (0.58%) and 290 cases (2.20%) diagnosed at hospitalisations.Risk of new AF at re-examination was 1.8-times higher for FEV1 between 60-80% of predicted compared with FEV1 o80% after adjustment for sex, age, smoking, blood pressure, diabetes and body mass index. The risk of AF hospitalisation was 1.3-times higher for FEV1 between 60-80% and 1.8-times higher for FEV1 v60% compared with FEV1 o80%, when additional adjustment was made for education, treatment with diuretics and chest pain at activity.The authors conclude that reduced lung function is an independent predictor for incident atrial fibrillation. The Copenhagen City Heart Study was funded by the Danish Heart Foundation. P. Buch was the recipient of a Danish Heart Foundation introduction grant (01-1-9-F3-22880).Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of cardiac arrhythmias. Hypoxaemia [1, 2], acidosis [3], cor pulmonale and coexisting ischaemic heart disease (IHD) [4,5] have been proposed as major causes for the relationship between COPD and arrhythmias. The risk of arrhythmias in patients with COPD is influenced by the state of the disease, with a higher frequency of supraventricular tachycardia during exacerbations [1, 2, 5]. However, even in patients with stable COPD the incidence of cardiac arrhythmias is considerable [6], and, in clinical practice, it is not uncommon to find atrial fibrillation (AF) in patients hospitalised for COPD. AF is by far the most common arrhythmia in the elderly population but only a few studies have analysed the relationship between lung function and the risk of developing AF in detail. It is important to investigate the correlation between reduced lung function and AF since the incidence of COPD is expected to increase considerably in the future, reflecting prior smoking habits of an ageing population [7,8]. The aim of the present study, therefore, was to investigate the role of reduced lung function in development of AF based on a representative sample of the general population free of IHD at baseline. Methods Study populationThis study was based on data from the Copenhagen City Heart Study (CCHS). The original cohort of CCHS comprised a random age-stratified sample of 19,329 males and females aged o20 yrs from an area of Copenha...
During the latest 10 to 20 years, there has been a 60% increase in hospital admissions for atrial fibrillation independent of changes in known risk factors. This increase could result from changes in admission threshold or coding practices, or it could reflect a genuine increase in the population incidence of atrial fibrillation.
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