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

Payal Kohli, Ph Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E. Magnus Ohman, Mark J. Alberts, Elaine Hoffman, Jianping Guo, Tabassome Simon, Emmanuel Sorbets, Shinya Goto, Deepak L. Bhatt

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume127
Issue number1
DOIs
StatePublished - Jan 2014

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Anti-Inflammatory Agents
Outpatients
Hospitalization
Stroke
Myocardial Infarction
Confidence Intervals
Heart Failure
Pharmaceutical Preparations
Ventricular Remodeling
Dyslipidemias
Drug Users
Proportional Hazards Models
Aspirin
Registries
Creatinine
Thrombosis
Ischemia
Salts
Hypertension
Health

Keywords

  • Heart failure
  • NSAID
  • Outcomes
  • Stable atherothrombosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. / Kohli, Payal; Steg, Ph Gabriel; Cannon, Christopher P.; Smith, Sidney C.; Eagle, Kim A.; Ohman, E. Magnus; Alberts, Mark J.; Hoffman, Elaine; Guo, Jianping; Simon, Tabassome; Sorbets, Emmanuel; Goto, Shinya; Bhatt, Deepak L.

In: American Journal of Medicine, Vol. 127, No. 1, 01.2014.

Research output: Contribution to journalArticle

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 2014, 'NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease', American Journal of Medicine, vol. 127, no. 1. https://doi.org/10.1016/j.amjmed.2013.08.017
Kohli, Payal ; Steg, Ph Gabriel ; Cannon, Christopher P. ; Smith, Sidney C. ; Eagle, Kim A. ; Ohman, E. Magnus ; Alberts, Mark J. ; Hoffman, Elaine ; Guo, Jianping ; Simon, Tabassome ; Sorbets, Emmanuel ; Goto, Shinya ; Bhatt, Deepak L. / NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. In: American Journal of Medicine. 2014 ; Vol. 127, No. 1.
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abstract = "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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AU - Kohli, Payal

AU - Steg, Ph Gabriel

AU - Cannon, Christopher P.

AU - Smith, Sidney C.

AU - Eagle, Kim A.

AU - Ohman, E. Magnus

AU - Alberts, Mark J.

AU - Hoffman, Elaine

AU - Guo, Jianping

AU - Simon, Tabassome

AU - Sorbets, Emmanuel

AU - Goto, Shinya

AU - Bhatt, Deepak L.

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N2 - 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.

AB - 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.

KW - Heart failure

KW - NSAID

KW - Outcomes

KW - Stable atherothrombosis

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