Risk of acute myocardial infarction during use of individual NSAIDs: A nested case-control study from the SOS project

Abstract

BackgroundUse of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used.ObjectivesTo estimate the risk of AMI for individual NSAIDs.MethodsA nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999–2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool).ResultsAmong 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83–2.32, ORpool 1.80; 1.49–2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03–1.22, ORpool 1.00;0.86–1.16). Higher doses showed higher risk estimates than lower doses.ConclusionsThe relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.

International Union of Basic and Clinical Pharmacology. CIX. Differences and Similarities between Human and Rodent Prostaglandin E2Receptors (EP1–4) and Prostacyclin Receptor (IP): Specific Roles in Pathophysiologic Conditions

“…In contrast, mostly EP3 agonists, such as sulprostone and misoprostol, which are used as clinical practice, are associated with an increased incidence of ischemic stroke or myocardial infarction in patients probably due to coronary constriction. Globally, these results suggest a strong role for the EP3 receptor in the control of arterial blood pressure (Guerci et al, 2013;Vital et al, 2013;Masclee et al, 2018;Mazhar et al, 2018;Schink et al, 2018). These in vivo observations are supported by the numerous in vitro data on the vasoconstrictor role of the EP3 receptor in human vasculature as mentioned previously (Qian et al, 1994;Norel et al, 2004a;Foudi et al, 2011;Longrois et al, 2012;Ozen et al, 2015).…”

Etoricoxib in the treatment of osteoarthritis

“…и соавт. [29] использовали базу данных крупного международного проекта SOS для оценки влияния различных 28 НПВП на риск развития ОИМ. Из 8,5 миллионов лиц, принимающих НПВП на момент исследования, было выявлено 79553 случаев ОИМ.…”

Tactics of Management of Patients with Back and Limb Pain

“…У лиц пожилого возраста фармакокинетический профиль нимесулида при назначении однократных и многократных/ повторных доз не изменялся. Оценка результатов лечения 8,5 млн человек (проект SOS) показала, что минимальными рисками в отношении развития острого инфаркта миокарда обладали нимесулид и кетопрофен, а максимальный риск наблюдался при употреблении кеторолака [33]. Нимесулид способен ингибировать выделение гистамина, что позволяет использовать его у пациентов со склонностью к развитию аспириновой астмы.…”