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Los antiinflamatorios no esteroideos, el acetaminofén y el riesgo de eventos cardiovasculares

Andrew T Chan¹, JoAnn E Manson, Christine M Albert

¹Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. achan@partners.org

|March 15, 2006

Resumen

El uso frecuente de medicamentos antiinflamatorios no esteroideos (AINE) o acetaminofén está relacionado con un mayor riesgo de eventos cardiovasculares. El uso moderado no mostró un aumento sustancial del riesgo, pero las dosis altas o la frecuencia elevaron significativamente los riesgos.

Área de la Ciencia:

Epidemiología cardiovascular.
Farmacología Farmacología.
Salud pública La salud pública.

Sus antecedentes:

Los ensayos aleatorizados indican un mayor riesgo cardiovascular con los inhibidores de la COX-2.
Los estudios sobre AINE no selectivos y acetaminofén muestran hallazgos de riesgo cardiovascular inconsistentes.

Objetivo del estudio:

Investigar la asociación entre el uso de antiinflamatorios no esteroideos (AINE) y acetaminofén y el riesgo de eventos cardiovasculares importantes.
Examinar las relaciones dosis-respuesta y la modificación del efecto por el estado de fumar.

Principales métodos:

Estudio de cohorte prospectivo de 70.971 mujeres de entre 44 y 69 años, libres de enfermedades cardiovasculares y cáncer.
Recopilación bienal de datos de medicación y seguimiento de 12 años para eventos cardiovasculares importantes (infarto de miocardio, accidente cerebrovascular, muerte por enfermedad coronaria).
Análisis estadístico ajustado por factores de riesgo cardiovascular, examinando el uso ocasional vs. frecuente y la relación dosis-respuesta.

Principales resultados:

El uso frecuente de AINE (> o = 22 d / mo) se asoció con un aumento de 1,44 veces el riesgo de eventos cardiovasculares (95% IC, 1,27-1,65).
El uso frecuente de acetaminofén (> o = 22 d / mo) se asoció con un riesgo 1,35 veces mayor (95% IC, 1,14-1,59).
Se observaron relaciones dosis-respuesta significativas; riesgo elevado de AINE (RR=1.86) y paracetamol (RR=1.68) en dosis semanales altas (> o =15 tabletas). El riesgo fue mayor en fumadores actuales.

Conclusiones:

El uso frecuente o dosis altas de AINE o acetaminofén se asocia con un riesgo significativamente mayor de eventos cardiovasculares importantes.
El uso moderado de estos analgésicos no confería un riesgo cardiovascular sustancial.

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