Differential effects of aspirin and non-aspirin nonsteroidal antiinflammatory drugs in the primary prevention of myocardial infarction in postmenopausal women.
The antiplatelet effect of aspirin reduces the risk of clinical manifestations of atherothrombosis by approximately 25% in secondary prevention settings. Data are limited in primary prevention of coronary heart disease, and even more in women. Here, we estimate the effects of aspirin and non-aspirin nonsteroidal antiinflammatory drugs in the primary prevention of myocardial infarction in postmenopausal women. We followed a cohort of 164,769 women, 50-74 years of age, registered in the General Practice Research Database in the United Kingdom, from January 1991 through December 1995. For aspirin and non-aspirin nonsteroidal antiinflammatory drugs, the risk of myocardial infarction associated with current use was compared with risk in non-users, using a nested case-control analysis. Overall, the relative risk of myocardial infarction associated with current use of aspirin of more than 1 month's duration was 0.56 [95% confidence interval (95% CI) = 0.26-1.21], and that of nonfatal myocardial infarction was 0.28 (95% CI = 0.08-0.91). Chronic use of nonsteroidal antiinflammatory drugs was not associated with a protective effect (relative risk = 1.32; 95% CI = 0.97-1.81). These findings indicate that incomplete and reversible inhibition of platelet cyclooxygenase by non-aspirin nonsteroidal antiinflammatory drugs is not sufficient to produce clinically detectable cardiovascular protection comparable with that achieved by low-dose aspirin through irreversible inactivation of platelet cyclooxygenase.
García Rodríguez
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Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain.
Varas
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Patrono
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D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D017698:Postmenopause; D011315:Preventive Medicine
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin