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dc.contributor.authorGudbjornsson, Bjorn
dc.contributor.authorThorsteinsson, Sigurdur B
dc.contributor.authorSigvaldason, Helgi
dc.contributor.authorEinarsdottir, Rannveig
dc.contributor.authorJohannsson, Magnus
dc.contributor.authorZoega, Helga
dc.contributor.authorHalldorsson, Matthias
dc.contributor.authorThorgeirsson, Gudmundur
dc.date.accessioned2011-01-26T11:42:25Z
dc.date.available2011-01-26T11:42:25Z
dc.date.issued2010-06
dc.date.submitted2011-02-26
dc.identifier.citationEur. J. Clin. Pharmacol. 2010, 66(6):619-25en
dc.identifier.issn1432-1041
dc.identifier.pmid20157701
dc.identifier.doi10.1007/s00228-010-0789-2
dc.identifier.urihttp://hdl.handle.net/2336/120390
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractPURPOSE: To examine the risk of thromboembolic cardiovascular events in users of coxibs and NSAIDs in a nationwide cohort. METHODS: Data were synchronised from three nationwide databases, the Icelandic Medicines Registry (IMR), The Icelandic National Patient Registry (INPR) and the Registry for Causes of Death at Statistics Iceland (RCD), for prescriptions for NSAIDs or coxibs with respect to hospitalisation for unstable angina pectoris, myocardial infarction and cerebral infarction over a 3-year period. The Cox proportional hazards model and Poisson regression were used to analyse the data. RESULTS: A total of 108,700 individuals received prescriptions for NSAIDs or coxibs (ATC code M01A), of whom 78,539 received one drug only (163,406 person-years). Among those receiving only one drug 426 individuals were discharged from hospital with endpoint diagnoses. In comparison to diclofenac, the incidence ratios, adjusted for age and gender, were significantly higher for cerebral infarction (2.13; 95% CI 1.54-2.97; P < 0.001), for myocardial infarction (1.77; 95% CI 1.34-2.32; P < 0.001) and for unstable angina pectoris (1.52; 95% CI 1.01-2.30; P = 0.047) for patients who used rofecoxib. For naproxen users, the incidence ratio was 1.46 for myocardial infarction (95% CI 1.03-2.07; P = 0.03), but was reduced in ibuprofen users (0.63; 95% CI 0.40-1.00; P = 0.05). The youngest users of rofecoxib (< or =39 years) had the highest hazard ratio (HR) for cardiovascular events (8.34; P < 0.001), while those > or =60 years had a lower but still significantly elevated HR (1.35; P = 0.001). CONCLUSION: This Icelandic nationwide registry-based study amounting to 163,406 patient-years showed increased risk of cardiovascular events, i.e. cerebral infarction, myocardial infarction and unstable angina pectoris, among rofecoxib and naproxen users in comparison to diclofenac users. The added risk was most pronounced in young adults using rofecoxib.
dc.language.isoenen
dc.publisherSpringer Verlagen
dc.relation.urlhttp://dx.doi.org/10.1007/s00228-010-0789-2en
dc.subject.meshAngina, Unstableen
dc.subject.meshCerebral Infarctionen
dc.subject.meshCyclooxygenase 2 Inhibitorsen
dc.subject.meshDatabases, Factualen
dc.subject.meshDeath, Suddenen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshIcelanden
dc.subject.meshIncidenceen
dc.subject.meshLactonesen
dc.subject.meshMaleen
dc.subject.meshMyocardial Infarctionen
dc.subject.meshOdds Ratioen
dc.subject.meshPyrazolesen
dc.subject.meshRegistriesen
dc.subject.meshRisk Factorsen
dc.subject.meshSulfonamidesen
dc.subject.meshSulfonesen
dc.subject.meshThromboembolismen
dc.subject.meshYoung Adulten
dc.titleRofecoxib, but not celecoxib, increases the risk of thromboembolic cardiovascular events in young adults-a nationwide registry-based studyen
dc.typeArticleen
dc.contributor.departmentCentre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland. bjorngu@landspitali.isen
dc.identifier.journalEuropean journal of clinical pharmacologyen
html.description.abstractPURPOSE: To examine the risk of thromboembolic cardiovascular events in users of coxibs and NSAIDs in a nationwide cohort. METHODS: Data were synchronised from three nationwide databases, the Icelandic Medicines Registry (IMR), The Icelandic National Patient Registry (INPR) and the Registry for Causes of Death at Statistics Iceland (RCD), for prescriptions for NSAIDs or coxibs with respect to hospitalisation for unstable angina pectoris, myocardial infarction and cerebral infarction over a 3-year period. The Cox proportional hazards model and Poisson regression were used to analyse the data. RESULTS: A total of 108,700 individuals received prescriptions for NSAIDs or coxibs (ATC code M01A), of whom 78,539 received one drug only (163,406 person-years). Among those receiving only one drug 426 individuals were discharged from hospital with endpoint diagnoses. In comparison to diclofenac, the incidence ratios, adjusted for age and gender, were significantly higher for cerebral infarction (2.13; 95% CI 1.54-2.97; P < 0.001), for myocardial infarction (1.77; 95% CI 1.34-2.32; P < 0.001) and for unstable angina pectoris (1.52; 95% CI 1.01-2.30; P = 0.047) for patients who used rofecoxib. For naproxen users, the incidence ratio was 1.46 for myocardial infarction (95% CI 1.03-2.07; P = 0.03), but was reduced in ibuprofen users (0.63; 95% CI 0.40-1.00; P = 0.05). The youngest users of rofecoxib (< or =39 years) had the highest hazard ratio (HR) for cardiovascular events (8.34; P < 0.001), while those > or =60 years had a lower but still significantly elevated HR (1.35; P = 0.001). CONCLUSION: This Icelandic nationwide registry-based study amounting to 163,406 patient-years showed increased risk of cardiovascular events, i.e. cerebral infarction, myocardial infarction and unstable angina pectoris, among rofecoxib and naproxen users in comparison to diclofenac users. The added risk was most pronounced in young adults using rofecoxib.


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