Meta-Analysis: Cardiovascular Events Associated with NSAI drugs

(refered by Marcelo Gustavo Colominas [mgcolominas@gigared.com])
Meta-Analysis: Cardiovascular Events Associated with
Nonsteroidal Anti-inflammatory Drugs
Shelley R. Salpeter, MD,a,b Peter Gregor, MD,b Thomas M. Ormiston, MD,b Richard Whitlock, MD,c
Parminder Raina, PhD,c,d Lehana Thabane, PhD,d,e Eric J. Topol, MDf
aStanford University School of Medicine, Stanford, Calif; bSanta Clara Valley Medical Center, San Jose, Calif; cMcMaster Evidencebased
Practice Centre, McMaster University, Hamilton, Ont, Canada; dDepartment of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Ont, Canada; eCentre for Evaluation of Medicines, Saint Joseph’s Healthcare, Hamilton, Ont,
Canada; fDepartment of Genetics, Case Western Reserve University, Cleveland, Ohio.
ABSTRACT
PURPOSE: We performed a meta-analysis of randomized controlled trials to assess the effect of
nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) on cardiovascular events in trials of joint disease and Alzheimer’s disease.
METHODS: We performed comprehensive searches of MEDLINE, EMBASE, CINAHL and Cochrane databases from 1966 to July 2005, and references of identified articles and reviews. We included randomized placebo-controlled trials of at least 6 weeks duration that evaluated nonselective NSAIDs in trials of joint disease or Alzheimer’s disease, and reported at least one cardiovascular event or death. The outcome measured was the composite of death, myocardial infarction or cerebrovascular accident, with the pooled results reported as odds ratios (OR). Subgroup analyses evaluated the difference between trials of joint disease and Alzheimer’s disease, and for naproxen and non-naproxen NSAIDs.
RESULTS: Pooled data from 13 trials with 7718 participants showed that nonselective NSAIDs had no significant effect on cardiovascular events (OR 1.3; 95% confidence interval [CI], 0.8 to 2.1). No significant effect was seen for joint disease trials (OR 0.6; 95% CI, 0.2 to 1.7) or Alzheimer disease trials (OR 1.6; 95% CI, 0.9 to 2.7). There was no significant difference in results for naproxen and non-naproxen NSAIDs.
CONCLUSION: Nonselective NSAIDs have no significant effect on cardiovascular events or death in trials of joint disease and Alzheimer disease, but a small adverse effect could not be excluded. An indication for risk was present in trials of Alzheimer’s disease but not in joint disease trials. There was no significant adverse or cardioprotective effect of naproxen. © 2006 Elsevier Inc. All rights reserved.