Limits...
Regular use of traditional analgesics predicts major coronary events: A cohort study.

Haara M, Heliövaara M, Arokoski JP, Knekt P, Manninen P, Aromaa A, Reunanen A, Impivaara O, Kröger H - Ther Clin Risk Manag (2009)

Bottom Line: The risk of a major coronary event was significantly elevated among those reporting regular use of analgesics at baseline.The risk was as high as 5.27 (95% CI 2.13-13.11) during the first two years of the follow-up.Therefore, the increased risk of major coronary events among regular users of analgesics is likely to be due to traditional NSAIDs.

View Article: PubMed Central - PubMed

Affiliation: Bone and Cartilage Research Unit (BCRU), University of Kuopio, Kuopio, Finland;

ABSTRACT

Aims: Serious concern has arisen about the cardiovascular safety of selective cyclo-oxygenase-2 (COX-2) inhibitors. However, recent studies have shown that the cardiovascular risks of regular use of traditional analgesics also deserve attention. We investigated the use of traditional analgesics for their prediction of major coronary events during 16 years of follow-up.

Methods: A population sample of 8000 Finns aged 30 years and over was invited to a comprehensive health examination in 1978-1980; 7217 (90%) complied, and 4824 of these had no diagnosed cardiovascular disease. The participants filled in a questionnaire eliciting information on the use of analgesics. Record linkage to the National Hospital Discharge Register and the mortality register of the Central Statistical Office of Finland identified 266 major coronary events (myocardial infarctions or coronary deaths) by the end of 1994.

Results: The risk of a major coronary event was significantly elevated among those reporting regular use of analgesics at baseline. Compared with nonusers and adjusted for known risk factors for coronary heart disease, the relative risk of an event during the whole follow-up period was 1.51 (95% confidence interval [CI] 1.08-2.10) among regular users of analgesics. The risk was as high as 5.27 (95% CI 2.13-13.11) during the first two years of the follow-up. Thereafter it leveled off.

Conclusion: Based on sales statistics almost all analgesics used in Finland at the end of the 1970's were nonsteroidal antiinflammatory drugs (NSAIDs). Therefore, the increased risk of major coronary events among regular users of analgesics is likely to be due to traditional NSAIDs.

No MeSH data available.


Related in: MedlinePlus

Sales statistics of simple analgesic preparations in Finland during the baseline study from 1978 to 1980 (excluding sales to hospitals).16*Notes: *The defined daily dose (DDD) is based on the average daily dose used for the main indication of the drug. Drug utilization in DDDs per 1000 inhabitants per day indicates the proportion of subjects receiving regular treatment with a particular drug during a given year.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2697508&req=5

f1-tcrm-5-0009: Sales statistics of simple analgesic preparations in Finland during the baseline study from 1978 to 1980 (excluding sales to hospitals).16*Notes: *The defined daily dose (DDD) is based on the average daily dose used for the main indication of the drug. Drug utilization in DDDs per 1000 inhabitants per day indicates the proportion of subjects receiving regular treatment with a particular drug during a given year.

Mentions: A major limitation of our study is the absence of specific information on the names and amounts of the analgesics used by the subjects at the time of the baseline study. However, the role of analgesics can be estimated on the basis of sales statistics of these drugs. At the time of the baseline study the sales statistics of simple NSAID preparations in Finland was topped by acetylsalicylic acid,16 followed by indomethacin, ibuprofen, naproxen, and ketoprofen (Figure 1). The use of paracetamol was very low in Finland at the time of the baseline study,16 (Figure 1.) and antimigraine preparations were also of little importance since they were not used on a regular basis.16 Most importantly, our results cannot be confounded by selective COX-2 inhibitors, because they were first introduced after the end of the follow-up period. Thus, most of the preparations used regularly for pain relief in this study cohort were likely to be traditional NSAIDs. It appears, therefore, that the increased risk of major coronary events in the present study is associated with regular use of traditional NSAIDs. However, analgesics use was only assessed at baseline which may not necessarily indicate long-term use throughout the follow-up. Furthermore, the lack of specific information on the analgesics and their dosing schemes does not allow any conclusion regarding possible causality between specific drugs and cardiovascular risk. Moreover, it has been suggested that concurrent use of acetosalisylic acid should be taken into account because this medicine could mitigate an increased risk of coronary events among some patients using other NSAIDs.17 However, our results are unlikely to be confounded by such joint medication because low-dose acetosalisylic acid was not used in Finland at the time of the baseline examination.


Regular use of traditional analgesics predicts major coronary events: A cohort study.

Haara M, Heliövaara M, Arokoski JP, Knekt P, Manninen P, Aromaa A, Reunanen A, Impivaara O, Kröger H - Ther Clin Risk Manag (2009)

Sales statistics of simple analgesic preparations in Finland during the baseline study from 1978 to 1980 (excluding sales to hospitals).16*Notes: *The defined daily dose (DDD) is based on the average daily dose used for the main indication of the drug. Drug utilization in DDDs per 1000 inhabitants per day indicates the proportion of subjects receiving regular treatment with a particular drug during a given year.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697508&req=5

f1-tcrm-5-0009: Sales statistics of simple analgesic preparations in Finland during the baseline study from 1978 to 1980 (excluding sales to hospitals).16*Notes: *The defined daily dose (DDD) is based on the average daily dose used for the main indication of the drug. Drug utilization in DDDs per 1000 inhabitants per day indicates the proportion of subjects receiving regular treatment with a particular drug during a given year.
Mentions: A major limitation of our study is the absence of specific information on the names and amounts of the analgesics used by the subjects at the time of the baseline study. However, the role of analgesics can be estimated on the basis of sales statistics of these drugs. At the time of the baseline study the sales statistics of simple NSAID preparations in Finland was topped by acetylsalicylic acid,16 followed by indomethacin, ibuprofen, naproxen, and ketoprofen (Figure 1). The use of paracetamol was very low in Finland at the time of the baseline study,16 (Figure 1.) and antimigraine preparations were also of little importance since they were not used on a regular basis.16 Most importantly, our results cannot be confounded by selective COX-2 inhibitors, because they were first introduced after the end of the follow-up period. Thus, most of the preparations used regularly for pain relief in this study cohort were likely to be traditional NSAIDs. It appears, therefore, that the increased risk of major coronary events in the present study is associated with regular use of traditional NSAIDs. However, analgesics use was only assessed at baseline which may not necessarily indicate long-term use throughout the follow-up. Furthermore, the lack of specific information on the analgesics and their dosing schemes does not allow any conclusion regarding possible causality between specific drugs and cardiovascular risk. Moreover, it has been suggested that concurrent use of acetosalisylic acid should be taken into account because this medicine could mitigate an increased risk of coronary events among some patients using other NSAIDs.17 However, our results are unlikely to be confounded by such joint medication because low-dose acetosalisylic acid was not used in Finland at the time of the baseline examination.

Bottom Line: The risk of a major coronary event was significantly elevated among those reporting regular use of analgesics at baseline.The risk was as high as 5.27 (95% CI 2.13-13.11) during the first two years of the follow-up.Therefore, the increased risk of major coronary events among regular users of analgesics is likely to be due to traditional NSAIDs.

View Article: PubMed Central - PubMed

Affiliation: Bone and Cartilage Research Unit (BCRU), University of Kuopio, Kuopio, Finland;

ABSTRACT

Aims: Serious concern has arisen about the cardiovascular safety of selective cyclo-oxygenase-2 (COX-2) inhibitors. However, recent studies have shown that the cardiovascular risks of regular use of traditional analgesics also deserve attention. We investigated the use of traditional analgesics for their prediction of major coronary events during 16 years of follow-up.

Methods: A population sample of 8000 Finns aged 30 years and over was invited to a comprehensive health examination in 1978-1980; 7217 (90%) complied, and 4824 of these had no diagnosed cardiovascular disease. The participants filled in a questionnaire eliciting information on the use of analgesics. Record linkage to the National Hospital Discharge Register and the mortality register of the Central Statistical Office of Finland identified 266 major coronary events (myocardial infarctions or coronary deaths) by the end of 1994.

Results: The risk of a major coronary event was significantly elevated among those reporting regular use of analgesics at baseline. Compared with nonusers and adjusted for known risk factors for coronary heart disease, the relative risk of an event during the whole follow-up period was 1.51 (95% confidence interval [CI] 1.08-2.10) among regular users of analgesics. The risk was as high as 5.27 (95% CI 2.13-13.11) during the first two years of the follow-up. Thereafter it leveled off.

Conclusion: Based on sales statistics almost all analgesics used in Finland at the end of the 1970's were nonsteroidal antiinflammatory drugs (NSAIDs). Therefore, the increased risk of major coronary events among regular users of analgesics is likely to be due to traditional NSAIDs.

No MeSH data available.


Related in: MedlinePlus