Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study.

Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Clinical Pharmacology &#38 Therapeutics (Impact Factor: 7.9). 12/2008; 85(2):190-7.
Source: PubMed


Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals, of whom 1,028,437 were included in the study after applying selection criteria. Compared to no NSAID use, hazard ratios (95% confidence limits) for death/myocardial infarction were 1.01 (0.96-1.07) for ibuprofen, 1.63 (1.52-1.76) for diclofenac, 0.97 (0.83-1.12) for naproxen, 2.13 (1.89-2.41) for rofecoxib, and 2.01 (1.78-2.27) for celecoxib. A dose-dependent increase in cardiovascular risk was seen for selective COX-2 inhibitors and diclofenac. Caution should be exercised in NSAID use in all individuals, and particularly high doses should be avoided if possible.

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    • "These include numerous harmful effects such as mucosal lesions, bleeding, peptic ulcers, and intestinal perforation [1] [2]. Other studies, meanwhile, have suggested that the side effects of NSAIDs are not limited only to GIT but extend to other serious complications such as acute renal failure, nephrotic syndrome, hypertension, and cardiovascular toxicity [3] [4] [5]. Recently, therefore, much effort has been devoted towards the discovery of alternative anti-inflammatory compounds of plant origin as potential natural and safe medicines without the harmful side effects of NSAIDs [6] [7] [8] [9] [10] [11]. "
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    ABSTRACT: For centuries, macrofungi have been used as food and medicine in different parts of the world. This is mainly attributed to their nutritional value as a potential source of carbohydrates, proteins, amino acids, and minerals. In addition, they also include many bioactive metabolites which make mushrooms and truffles common components in folk medicine, especially in Africa, theMiddle East, China, and Japan. The reported medicinal effects of mushrooms include anti-inflammatory effects, with anti-inflammatory compounds ofmushrooms comprising a highly diversified group in terms of their chemical structure.They include polysaccharides, terpenoids, phenolic compounds, andmany other lowmolecularweightmolecules.The aims of this revieware to report the different types of bioactive metabolites and their relevant producers, as well as the differentmechanisms of action ofmushroomcompounds as potent anti-inflammatory agents.
    Mediators of Inflammation 11/2014; 2014(805841):15. DOI:10.1155/2014/805841 · 3.24 Impact Factor
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    • "At 36 months there was a notable reduction in coxib usage which may reflect the withdrawal of rofecoxib and valdecoxib from the U.S. market. The decrease in coxib use at 36 months is likely reflective of both changes in medication availability and increasing awareness of toxicity during this period [24,26,38]. "
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    ABSTRACT: The aim of this analysis was to comprehensively describe cross-sectional and longitudinal patterns of analgesic and nutraceutical medication use for knee osteoarthritis (OA) in a contemporary US cohort and to investigate associated demographic and clinical factors. Baseline, 12, 24 and 36 month data were obtained retrospectively from the NIH Osteoarthritis Initiative. Participants had symptomatic radiographic knee OA. Multiple binary logistic regression models identified characteristics independently associated with use of analgesics or nutraceuticals. We included 987 subjects (55.9% female, mean age 61.5 years, 71.0% white). At baseline 68.2% reported frequent use of a conventional analgesic or nutraceutical for joint pain (for more than half of the previous month). Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently reported medications (26.8%), even in those aged over 75. Multiple conventional analgesics were used by 11.9%. Frequent analgesic use was more likely in females (OR 1.8 [CI 1.3-2.3]) and people with more pain (moderate 1.7 [1.2-2.4]; severe 3.1 [2.1-4.7]); nutraceutical use was less likely in non-whites (0.4 [0.3-0.6]), those aged over 74 years (0.6 [0.3-0.9]) and those with comorbidities (0.6 [0.5-0.9]) and more likely in people with Kellgren-Lawrence (KL) grade 4 (2.2 [1.5-3.3]). Overall there was no change in the proportion of participants frequently using prescription or over the counter (OTC) analgesics at 36 months, though most people had changed medication type; of those using a traditional analgesic at baseline approximately one third were still using the same type at 36 months (ranging from 26.2% of baseline prescription NSAID users to 40.6% of baseline acetaminophen users). All participants reporting baseline analgesic use also reported 36 month analgesic use. Female participants (OR 95% CI 1.2-3.2, P=0.009), those with high BMI (1.2-4.8, P=0.010) and those with moderate (1.6-2.6, P=0.090) or severe (1.8-12.0, P=0.002) baseline pain were more likely to use pain medication during the 36 month follow-up period; participants aged over 75 years less likely (0.2-1.0, P=0.053). Most people with knee OA used pharmacological therapies frequently, and use appeared to be according to American College of Rheumatology recommendations. Change in medication type used was common. Persistent non-prescription NSAID use in the elderly is an area of concern.
    Arthritis research & therapy 09/2013; 15(5):R106. DOI:10.1186/ar4286 · 3.75 Impact Factor
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    • "In some randomized clinical trials, it was judged that NSAIDs were more effective for pain control than acetaminophen. NSAIDs, however, were reported to accompany gastrointestinal side effects including peptic ulcer,4) increased the risk of myocardial infarction5) and heart failure,6) and the probability of side effects was proportional to dose. Additionally, there has not been consistency in the results of randomized clinical trials of these drugs on the pain control of tension type headache, and there have not been systematic reviews or meta-analyses comprehensively comparing the effects of those two drugs. "
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    ABSTRACT: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies. We searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics. We identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I(2) = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I(2) = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I(2) = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I(2) = 0%). In this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.
    09/2012; 33(5):262-71. DOI:10.4082/kjfm.2012.33.5.262
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