Olivier Barthélémy1, Tobias Limbourg2, Jean Philippe Collet1, Farzin Beygui1, Johanne Silvain1, Anne Bellemain-Appaix1, Guillaume Cayla1, Thomas Chastre1, Iris Baumgartner3, Joachim Röther4, Uwe Zeymer2, Deepak L Bhatt5, Gabriel Steg6, Gilles Montalescot7. 1. Institut de Cardiologie (APHP), INSERM CMR937 and Univ Paris 6, Pitié-Salpêtrière Hospital, Paris, France. 2. Institut für Herzinfarktforschung Ludwigshafen, an der Universität Heidelberg, Ludwigshafen, Germany. 3. Swiss Cardiovascular Centre, Division of Clinical and Interventional Angiology, Inselspital, University Hospital, 3010 Bern, Switzerland. 4. Department of Neurology, Asklepios Klinik Altona, Hamburg Medical School, Hamburg, Germany. 5. VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA. 6. INSERM U-698, Université Paris 7 and AP-HP, Paris, France. 7. Institut de Cardiologie (APHP), INSERM CMR937 and Univ Paris 6, Pitié-Salpêtrière Hospital, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr.
Abstract
BACKGROUND: We aimed to assess whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of cardiovascular (CV) events in stable patients with established atherothrombosis or multiple risk factors. METHODS: We analysed the 23,728 European patients of the REACH Registry; 20,588 (86.8%) had established atherothrombotic disease and 3140 (13.2%) had multiple risk factors only. Aspirin (ASA) and/or NSAIDs use was determined at enrolment and ischemic events were recorded over two years of follow-up. cMACCE was defined as the composite of CV death, MI or stroke. Bleeding was defined as any bleeding leading to both hospitalisation and transfusion. RESULTS: The mean age of population was 67.2±9.8years. At baseline, 1573 patients (6.6%) received NSAIDs and 15,395 (64.9%) received ASA. Four groups were defined: 1) no ASA/no NSAIDs, 2) ASA only, 3) NSAIDs only, 4) NSAIDs+ASA, with 7722 (32.5%), 14,433 (60.8%), 611 (2.6%) and 962 (4.1%) patients in these groups, respectively. Among the 22,028 (92.8%) with complete 2-year follow-up, 683 (3.2%) died from CV causes, while 395 (1.9%) had MI, 665 (3.1%) stroke, 1651 (7.6%) cMACCE and 199 (1.0%) bleeding. After adjustment, NSAID use was independently associated with an increased risk of stroke (OR 1.635; 95% CI 1.239-2.159, p<0.001), and a trend towards an increased bleeding rate (OR 1.554; CI 95% 0.960-2.51, p=0.07). No association was found between NSAID use and MI or MACCE. CONCLUSIONS: In stable atherothrombosis patients, the use of NSAIDs appears to be independently associated with an increased cerebrovascular event risk.
BACKGROUND: We aimed to assess whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of cardiovascular (CV) events in stable patients with established atherothrombosis or multiple risk factors. METHODS: We analysed the 23,728 European patients of the REACH Registry; 20,588 (86.8%) had established atherothrombotic disease and 3140 (13.2%) had multiple risk factors only. Aspirin (ASA) and/or NSAIDs use was determined at enrolment and ischemic events were recorded over two years of follow-up. cMACCE was defined as the composite of CV death, MI or stroke. Bleeding was defined as any bleeding leading to both hospitalisation and transfusion. RESULTS: The mean age of population was 67.2±9.8years. At baseline, 1573 patients (6.6%) received NSAIDs and 15,395 (64.9%) received ASA. Four groups were defined: 1) no ASA/no NSAIDs, 2) ASA only, 3) NSAIDs only, 4) NSAIDs+ASA, with 7722 (32.5%), 14,433 (60.8%), 611 (2.6%) and 962 (4.1%) patients in these groups, respectively. Among the 22,028 (92.8%) with complete 2-year follow-up, 683 (3.2%) died from CV causes, while 395 (1.9%) had MI, 665 (3.1%) stroke, 1651 (7.6%) cMACCE and 199 (1.0%) bleeding. After adjustment, NSAID use was independently associated with an increased risk of stroke (OR 1.635; 95% CI 1.239-2.159, p<0.001), and a trend towards an increased bleeding rate (OR 1.554; CI 95% 0.960-2.51, p=0.07). No association was found between NSAID use and MI or MACCE. CONCLUSIONS: In stable atherothrombosispatients, the use of NSAIDs appears to be independently associated with an increased cerebrovascular event risk.