title: Effect of selective cyclooxygenase 2 inhibitors and naproxen on short-term risk of acute myocardial infarction in the elderly.
abstract: BACKGROUND
  Recent debate has emerged regarding the cardiovascular safety of selective cyclooxygenase 2 inhibitors and the possible cardioprotective effect of naproxen sodium. We compared the rates of acute myocardial infarction (AMI) among elderly patients dispensed selective cyclooxygenase 2 inhibitors, naproxen, and nonselective nonnaproxen nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  METHODS
  We conducted a population-based retrospective cohort study using administrative health care data from Ontario, Canada, from April 1, 1998, to March 31, 2001. We identified NSAID-naive cohorts of subjects aged 66 years and older in whom treatment was initiated with celecoxib (n = 15 271), rofecoxib (n = 12 156), naproxen (n = 5669), and nonnaproxen nonselective NSAIDs (n = 33 868), along with a randomly selected control cohort not exposed to NSAIDs (n = 100 000). Multivariate Cox proportional hazards models were used to compare AMI rates between study drug groups while controlling for potential confounders.
  
  
  RESULTS
  Relative to control subjects, the multivariate model showed no significant differences in AMI risk for new users of celecoxib (adjusted rate ratio [aRR], 0.9; 95% confidence interval [CI], 0.7-1.2), rofecoxib (aRR, 1.0; 95% CI, 0.8-1.4), naproxen (aRR, 1.0; 95% CI, 0.6-1.7), or nonnaproxen nonselective NSAIDs (aRR, 1.2; 95% CI, 0.9-1.4).
  
  
  CONCLUSIONS
  The findings of this observational study suggest no increase in the short-term risk of AMI among users of selective cyclooxygenase 2 inhibitors as commonly used in clinical practice. Furthermore, the findings do not support a short-term reduced risk of AMI with naproxen.
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Ave-G215, Toronto, Ontario, Canada M4N 3M5. muhammad.mamdani@ices.on.ca
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Alex
authors.initials: A
authors.lastname: Kopp
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007783:Lactones / Q000009:adverse effects; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology; D009288:Naproxen / Q000009:adverse effects*; D009864:Ontario / Q000453:epidemiology; D016016:Proportional Hazards Models; D011720:Pyrazoles; D012189:Retrospective Studies; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects; D013450:Sulfones
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D009288:Naproxen; D000068579:Celecoxib