RESEARCH - Antirheumatic drug use and the risk of acute myocardial infarction

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Arthritis Rheum. 2006 Aug 15;55(4):531-6.

Antirheumatic drug use and the risk of acute myocardial infarction.

McGill University Health Centre, Montreal, Canada.

samy.suissa@...

OBJECTIVE: To assess the risk of acute myocardial infarction (AMI)

associated with the use of disease-modifying antirheumatic drugs (DMARDs)

and other medications commonly used in rheumatoid arthritis (RA). METHODS:

We conducted a nested case-control analysis within a cohort of subjects with

RA, observed between 1999 and 2003, identified from the PharMetrics claims

database. For each first AMI hospitalization identified during followup, 10

controls matched on sex, age, and time of study entry were randomly selected

from the cohort. Conditional logistic regression was used to estimate the

rate ratio (RR) of AMI associated with the current use of anti-RA therapy,

as measured from dispensed prescriptions, after adjustment for AMI risk

factors. RESULTS: The cohort included 107,908 subjects (average age 54 years

at cohort entry). During followup, 558 AMI cases occurred (3.4 per 1,000 per

year). AMI rate was significantly decreased with the current use of any

DMARD (adjusted RR 0.80, 95% confidence interval [95% CI] 0.65-0.98). This

effect was consistent across all DMARDs, including methotrexate (RR 0.81,

95% CI 0.60-1.08), leflunomide (RR 0.28, 95% CI 0.12-0.65), and other

traditional DMARDs (RR 0.67, 95% CI 0.46-0.97), but not biologic agents (RR

1.30, 95% CI 0.92-1.83). AMI rate increased with the use of glucocorticoids

(RR 1.32, 95% CI 1.02-1.72) but not with nonselective nonsteroidal

antiinflammatory drugs (RR 1.05, 95% CI 0.81-1.36) or cyclooxygenase 2

(COX-2) inhibitors (RR 1.11, 95% CI 0.87-1.43).

CONCLUSION: DMARD use is associated with a reduction in AMI risk in patients

with RA. No risk increase was found with the COX-2 inhibitors in this

population.

PMID: 16874796

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16874796

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