Intravascular inflammation has a si...

Intravascular inflammation has a significant part in the development of acute coronary issues and atherosclerosis. Nonsteroidal anti-inflammatory remedys (NSAIDs) are used to treat pain syndrome render inflammation, and inhibit platelet aggregation. In theory, these properties should change into the risk for acute myocardial infarction (MI), on the other hand recent observational studies did not support this. These studies were limited in that they did not distinguish between the weights of the inflammation prompting the use of NSAIDs and the potential tenor of NSAIDs on acute MI risk. In united study, the relative risk for acute MI in patients who used NSAIDs continuously was no different than that of the manage group, but those who discontinued NSAIDs had a double increase in the risk for acute MI. Fischer and colleagues evaluated the association between the timing of discontinuation of NSAIDs and the risk for first-time acute MI.

The trial design was a case-controlled analysis in succession the British General Practice Research Database. The database included information from more than 3 million patients registered with a collection of general practitioners who provided data for research drifts The information included patient demographics and characteristics, symptoms, clinical diagnoses, referrals to consultants, hospitalizations, and prescriptions. Patients in the database who were diagnosed with acute MI were included in the reflection In addition, a matched regulate group was identified and had the same analyses performed. NSAID outlook was identified using the database. existing users were those who had a prescription for NSAIDs that went to or beyond the index date. Those who discontinued the NSAIDs were classified into three collections according to days between extreme point of therapy and the index date (one to 29 30 to 59 and 60 or more days). They were also classified according to the number of prescriptions for NSAIDs.

There were 8688 patients identified who had a first-time acute MI between 1995 and 2001 and the rule group included 33,923 matched rule patients. Patients who discontinued NSAIDs individual to 29 days before the index date had an adjusted supernumerarys ratio for acute MI that was 152 (95% confidence interval [CI], 133 to 174) compared with nonusers after adjusting for multiple factors. Patients who had rheumatoid arthritis or systemic lupus erythematosus had the highest risk for acute MI when they discontinued NSAIDs after long-term use. Individuals who discontinued NSAIDs after previous long-term use had an adjusted left over s ratio of 2.60 (95% CI, 184 to 368) for acute MI when compared with the rule group. Current NSAID users and those who had discontinued therapy more than 60 days ago had the same risk of acute MI, and it was not increased compared with the superintendence group.

The authors judge that the risk for acute MI is elevated after discontinuation of NSAIDs in patients upon long-term therapy, and this drift may last for several weeks. They add that the risk for common NSAID use and acute MI was not elevated. Physicians should be cautious about abrupt discontinuation of NSAIDs in patients receiving long-term therapy.

EDITOR'S NOTE: A significant amount of information about cyclooxygenase-2 (COX-2) inhibitors and naproxen (Aleve) and the potential increased risk for cardiovascular adventures especially with prolonged use and in high-risk settings (i.e., after heart surgery) has accumulated. This l the U diet and Drug Administration (FDA) to publish an advisory about the use of these medications. (1) The basic message is that physicians should take into consideration the patient's risk factors when prescribing COX-2 inhibitors and nonsteroidal anti-inflammatory remedys (NSAIDs). The study discussed above demonstrates an increase in the risk for acute coronary syndrome in patients who discontinue NSAIDs. In its recommendation, the FDA stated that the data were preliminary in the studies they referenc and that the ensues conflict with data from other studies of the same medications.1 Physicians ne to be aware of the potential risks and benefits of these classes of medications and share this information with their patients.--K.E.M.

REFFERENCE

(1) FDA issues public health advisory recommending limited use of COX-2 inhibitors. Agency requires evaluation of prevention studies involving COX-2 selective agents. U forage and Drug Administration, 2004. Accessed online March 11 2005 at: http://www.fda. gov/bbs/topics/answers/2004/ans01336.html.

KARL E MILLER, MD

Fischer LM et al. Discontinuation of nonsteroidal anti-inflammatory unsalable article therapy and risk of acute myocardial infarction. Arch Intern M December 13/27 2004;164:2472-6

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