非ステロイド性抗炎症薬,アセトアミノフェン,心血管疾患のリスク
Andrew T Chan1, JoAnn E Manson, Christine M Albert
1Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. achan@partners.org
Circulation
|March 15, 2006
まとめ
非ステロイド性抗炎症薬 (NSAIDs) またはアセトアミノフェンの頻繁な使用は,心血管疾患のリスクの増加と関連しています. 適度な使用は実質的なリスク増加を示さなかったが,高用量または高頻度ではリスクが著しく上昇した.
科学分野:
- 心血管疾患の疫学について
- 薬理学 薬理学とは
- 公衆衛生は公衆衛生である.
背景:
- ランダム化試験は,COX-2阻害剤で心血管疾患のリスクが増加することを示しています.
- 非選択的NSAIDとアセトアミノフェンの研究では,心血管リスクの見積もりが一貫していないことが示されています.
研究 の 目的:
- 非ステロイド性抗炎症薬 (NSAID) とアセトアミノフェンの使用と主要な心血管疾患のリスクとの関連を調査する.
- ドス・レスポンス関係と喫煙状態による効果変化を検証する.
主な方法:
- 44~69歳の女性70,971人を対象とした前向きなコホート研究で,心臓血管疾患や癌がない.
- 2年に一度の医薬品データ収集と12年間の主要心血管疾患 (心筋梗塞,脳卒中,冠動脈疾患による死亡) の追跡調査.
- 心血管疾患の危険因子に調整された統計分析で,偶発的 vs. 頻繁な使用と用量-反応を調査した.
主要な成果:
- 頻繁なNSAID使用 (>または=22d/mo) は,心血管疾患のリスクが1.44倍増加 (95%CI,1.27-1.65) と関連していました.
- アセトアミノフェンの頻繁な使用 (>または=22d/mo) は,1.35倍のリスク増加 (95%CI,1.14-1.59) と関連していました.
- 重要な用量反応関係が観察され,NSAID (RR=1.86) とアセトアミノフェン (RR=1.68) のリスクが高かった. リスクは,現在の喫煙者において高かった.
結論:
- 高頻度または高用量のNSAIDまたはアセトアミノフェンの使用は,主要な心血管疾患のリスクを大幅に増加させる.
- これらの鎮痛剤の適度な使用は,実質的な心血管疾患のリスクを与えない.
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