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Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used prescription and over-the-counter analgesic medications worldwide. NSAID toxicity, however, limits their use by raising cardio-renal morbidity and mortality risk. Withdrawal of the balancing vasodilatory prostaglandins on vascular, thrombotic, and renal physiological mechanisms by NSAIDs contributes to the cardio-cerebro-renal vascular event risk. We hypothesized that restoration of prostanoids through the concomitant use of misoprostol with NSAIDs may reduce the adverse event risk.
Methods: A historical cohort study design was implemented using the U.S. Veterans Affairs database to compare new initiators of NSAIDs and/or misoprostol from 01/01/2005 — 12/31/2013 (N=1,687,581). Subjects were followed for 5 years for cardiovascular (AMI, cardiac arrest, ventricular fibrillation), cerebrovascular (CVA, TIA), or renal-vascular (renal failure) events. Confounders were evaluated on eleven categories and forty-eight pre-treatment baseline covariates. Regression modeling based on propensity score (PS) matched weights was used to adjust for measured confounding and compare the treatment groups.
Results: After PS weighting, both treatment groups contained 1827 patients. NSAID plus misoprostol significantly reduced cardiovascular, cerebrovascular, and reno-vascular endpoints vs. NSAID alone. Cardiovascular endpoints: HR: 0.56 (95% CI: 0.34-0.94); cerebrovascular endpoints: HR: 0.75 (95% CI: 0.60-0.95); and reno-vascular endpoints: HR: 0.66 (95% CI: 0.49-0.0.89). All-cause mortality was not statistically different between groups HR: 1.05 (95% CI: 0.87-1.25).
Conclusions: Taking misoprostol in conjunction with a NSAID significantly reduced the risk of NSAID-induced cardiovascular, cerebrovascular, and reno-vascular adverse events associated with taking NSAIDS alone. This data from a large and well characterized healthcare system database supports a safer analgesic, an NSAID combined with misoprostol.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Current Issues in Cardiovascular Epidemiology, Disparities, and Safety
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1148-068
- 2017 American College of Cardiology Foundation