Acute myocardial infarction with oral nonsteroidal anti-inflammatory drugs in real-world use
Notice bibliographique
Résumé
Background: It is generally accepted that oral nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of acute myocardial infarction (MI). However, the attributes of exposure that explain any excess risk have been incompletely investigated.Objective: For each studied NSAID, the objectives were to determine the relationship between acute MI and daily dose and to precisely characterize the time course of any increased risk – in terms of onset and possible cumulative effect – as well as to assess clinical heterogeneity due to the presence of major cardiovascular risk profiles. Methods: These questions were investigated as follows: 1) A one-stage Bayesian individual patient data meta-analysis (IPD MA) was carried out using internally-valid healthcare database studies reporting MI risks with common traditional NSAIDs, celecoxib, and rofecoxib. This study characterized the acute MI risk of each NSAID according to recency of use, duration, and dose by modelling drug exposure as a multidimensional indicator variable. Adjusted median pooled odds ratios (ORs) of acute MI were calculated for each 'recency-dose-duration' category of NSAID use. The primary endpoint of the IPD MA was the posterior probability that pooled ORs of MI exceeded pre-specified risk thresholds. 2) A cohort of elderly patients from the computerized public insurance databases of Quebec, Canada (RAMQ) was created to further examine the NSAID dose-MI risk relationship and its time course. The two analytical methods employed were a standard nested case control analysis and recency-weighted cumulative exposure (WCE) analyses. WCE analyses allowed further characterizing the onset of risk and the existence of a temporal relationship between current MI risk and past NSAID exposure. 3) The clinical heterogeneity of MI associated with current NSAID use was also assessed in the RAMQ study. The joint effects of each NSAID and each of the following CV risk profiles: diabetes, hypertension, coronary heart disease, previous MI, and concurrent use of cardioprotective aspirin were evaluated on the additive scale by calculating the relative excess risk due to interaction (RERI). Results: In this doctoral research, 1) A total of 61 460 cases of acute MI in 446 763 individuals from four database studies (Provinces of Quebec and of Saskatchewan [Canada], Finland, and the UK) were meta-analyzed, of which 21 256 cases among 233 816 individuals originated from Quebec (RAMQ). In this IPD MA, compared with non-use of any NSAIDs in the year preceding the index date, risks of acute MI were increased with all current NSAID use. Onset of risk occurred within the first week of exposure. Short-term use of high daily doses (celecoxib > 200 mg, diclofenac > 100 mg, ibuprofen > 1200 mg, and naproxen > 750 mg) were found to be associated with the greatest harms, without obvious further increases in MI risk beyond the first month of treatment. With use for 1 month or less, there is at least an 80% probability of MI risk increase by 5-10% for celecoxib, by 5-30% for diclofenac, by 25-35% for ibuprofen, by 30-45% for naproxen, and by 35-100% for rofecoxib.2)The RAMQ study confirmed a dose-related increased risk of MI with all NSAIDs. Hazard ratios (95%CI) for current dose versus non-use in the preceding year, for the most common daily doses were: celecoxib 200 mg: 1.16 (1.10, 1.22), diclofenac 150 mg: 1.59 (1.38, 1.84), ibuprofen 1200 mg: 1.42 (1.17, 1.74), naproxen 750 mg: 1.38 (1.21, 1.58), and rofecoxib 25 mg: 1.54 (1.43, 1.66). Rofecoxib exhibited the strongest dose-response relationship, 2.38 (2.05, 2.76) with 50 mg, whereas dose-MI risk responses were more modest for the other NSAIDs. WCE models suggest that the risk increases immediately with exposure to NSAIDs but that doses taken in the past 2 weeks (rofecoxib), up to 1 month ago (ibuprofen and naproxen) and up to 2 months ago (diclofenac and celecoxib) may also contribute to the current risk of acute MI.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,005 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».