Abstract 12424: Effects of Chronic Nonsteroidal Anti-inflammatory Drugs Among Patients with Hypertension and Coronary Artery Disease: Post Hoc Analysis from the INVEST Trial
Introduction: There is limited information regarding the safety of chronic nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with hypertension and coronary artery disease (CAD). The aim of this research was to explore the relationship between chronic NSAID use and adverse events among hypertensive patients with CAD.
Methods: This was a post-hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST) which enrolled patients with hypertension and CAD and explored the effect of 2 different anti-hypertensive strategies. At each visit, patients were asked by site investigators if they were currently taking NSAIDs (and/or aspirin). Patients who reported NSAID use at every visit were defined as chronic NSAID users, while everyone else (occasional or never users) was defined as non-chronic NSAID users. The primary outcome was the first occurrence of all-cause death, non-fatal myocardial infarction, or non-fatal stroke. Cox regression was used to construct a multivariate analysis to explore associations between chronic NSAID use and adverse outcomes.
Results: There was 882 chronic NSAID users and 21,694 non-chronic NSAID users. Chronic NSAIDS users were younger, had lower blood pressure, more frequently were women with a history of diabetes, hypercholesterolemia, and peripheral arterial disease, and less frequently had a history of myocardial infarction or stroke. At a mean follow-up of 2.7 years (60,970 patient-years), the cumulative incidence of the primary outcome was 10.8% in chronic NSAID users versus 10.0% in non-chronic NSAID users (adjusted hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.25 to 1.91, p <0.0001). The incidence of all-cause mortality was 10.7% versus 7.7% (adjusted HR = 1.90, 95% CI 1.53 to 2.35), respectively. The hazard for the primary outcome persisted in an additional model that controlled for chronic aspirin use (adjusted HR = 1.38, 95% CI 1.11 to 1.70).
Conclusions: Among hypertensive patients with CAD, chronic NSAID use was associated with an increased risk of the primary outcome, as well as all-cause mortality during long-term follow-up. This harmful association remained after controlling for chronic aspirin use.
- © 2010 by American Heart Association, Inc.