doi: 10.1161/CIRCULATIONAHA.106.629824
(Circulation. 2006;114:e495.)
© 2006 American Heart Association, Inc.
Correspondence |
Letter by Kurth Regarding Article, "Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events"
Divisions of Aging and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School and, Department of Epidemiology, Harvard School of Public Health, Boston, Mass
The study by Chan and colleagues1 evaluated the association between use of nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen and the risk of major cardiovascular disease in apparently healthy women. Their study showed a statistically significant increased risk among women who used NSAIDs or acetaminophen 
22 days per month. In their discussion, the authors cited a secondary analysis from the Physicians’ Health Study that regular NSAID use (use of NSAIDS 60 days per year) was associated with a nearly 3-fold higher risk of myocardial infarction among men randomly assigned to aspirin as supportive evidence that NSAID use is associated with increased risk of myocardial infarction. In this analysis,2 however, the authors were only evaluating whether concomitant use of NSAIDs modifies the beneficial effect of aspirin on first myocardial infarction. Specifically, this finding must be considered in the context of other Physicians’ Health Study results. The main finding of the Physicians’ Health Study was a highly statistically significant 44% reduction in risk of first myocardial infarction for men randomly assigned to 325 mg aspirin every other day compared with men randomly assigned to placebo.3 On the basis of a biologically plausible mechanism,4 we evaluated in secondary analyses whether NSAID use inhibits this beneficial effect. We found that the relative risk of myocardial infarction was 1.57 (95% confidence interval, 0.70 to 3.56) for men assigned to aspirin who initiated use of NSAIDs 60 days per year and 0.21 (95% confidence interval, 0.03 to 1.50) for men assigned to placebo who additionally used NSAIDs 60 days per year when compared with men assigned to placebo who did not initiate any NSAID use.2 Thus, the risk reduction of myocardial infarction by aspirin was not apparent among those men assigned to aspirin who initiated NSAIDs 60 days per year. Taking this result into consideration, it would be expected that in stratified analyses, men randomly assigned to aspirin who concomitantly used NSAIDs regularly would have an apparent increased risk of myocardial infarction, as NSAID users were compared with men who had the biggest benefit (that is, those randomly assigned to aspirin who did not initiate any NSAID use). Thus, the result of the secondary analyses of the Physicians’ Health Study does not suggest that NSAID use is associated with increased risk of myocardial infarction among men randomly assigned to aspirin but rather that regular NSAID use inhibited the clinical benefit of aspirin on first myocardial infarction.2
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Acknowledgments |
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Disclosures
Dr Kurth has received investigator-initiated, research grants from Bayer AG, McNeil Consumer & Specialty Pharmaceuticals, and Wyeth Consumer Healthcare.
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References |
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 Top References |
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- Chan AT, Manson JE, Albert CM, Chea CU, Rexrode KM, Curhan GC, Rimm EB, Willett WC, Fuchs CS. Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events. Circulation. 2006; 113: 1578–1587.
[Abstract/Free Full Text] - Kurth T, Glynn RJ, Walker AM, Chan KA, Buring JE, Hennekens CH, Gaziano JM. Inhibition of clinical benefits of aspirin on first myocardial infarction by nonsteroidal antiinflammatory drugs. Circulation. 2003; 108: 1191–1195.[CrossRef][Medline]
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- Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989; 321: 129–135.[Abstract]
- Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, Vyas SN, FitzGerald GA. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001; 345: 1809–1817.
[Abstract/Free Full Text]
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