title: Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident.
abstract: OBJECTIVE
  To assess degree of cyclooxygenase-2 (COX-2) selectivity of a non-steroidal anti-inflammatory drug (NSAID) and risk of myocardial infarction (MI) or cerebrovascular accident (CVA).
  
  
  METHODS
  Prescription fill data were linked to medical records of a merged VA-Medicare dataset. NSAIDs were categorized by Cox-2 selectivity. Incidence of CVA and MI within 180 days of index prescription was assessed using Cox-proportional hazards models adjusted for gender, race, cardiovascular and pharmacological risk factors and propensity for prescription of highly COX-2 selective NSAIDs.
  
  
  RESULTS
  Of 384,322 patients (97.5% men and 85.4% white), 79.4% were prescribed a poorly selective, 16.4% a moderately selective and 4.2% a highly selective NSAID. There were 985 incident cases of MI and 586 cases of CVA in >145 870 person-years. Highly selective agents had the highest rate of MI (12.3 per 1000 person-years; [95% CI: 12.2-12.3]) and CVA (8.1 per 1000 person-years; [95% CI: 8.0-8.2]). Periods without NSAID exposure were associated with lowest risk. In adjusted models, highly selective COX-2 selective NSAIDs were associated with a 61% increase in CVA and a 47% increase in MI, when compared with poorly selective NSAIDs.
  
  
  CONCLUSIONS
  The risk of MI and CVA increases with any NSAID. Highly COX-2 selective NSAIDs confer the greatest risk.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, and Deparment of Gastroenterology, Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX 77030, USA. nabraham@bcm.tmc.edu
authors.forename: N S
authors.initials: NS
authors.lastname: Abraham
authors.forename: H B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: C
authors.initials: C
authors.lastname: Hartman
authors.forename: P
authors.initials: P
authors.lastname: Richardson
authors.forename: A
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced / Q000517:prevention & control*; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors