PMID- 18397385
OWN - NLM
STAT- MEDLINE
DCOM- 20081210
LR  - 20080605
IS  - 1365-2036 (Electronic)
IS  - 0269-2813 (Linking)
VI  - 28
IP  - 1
DP  - 2008 Jul
TI  - National mortality following upper gastrointestinal or cardiovascular events in 
      older veterans with recent nonsteroidal anti-inflammatory drug use.
PG  - 97-106
LID - 10.1111/j.1365-2036.2008.03706.x [doi]
AB  - BACKGROUND: Upper gastrointestinal events (UGIE), myocardial infarction (MI) and 
      cerebrovascular accident (CVA) are known morbidities among recent NSAID users. 
      AIM: To assess all-cause mortality following UGIE, MI or CVA among recent NSAID 
      users. METHODS: Veterans >65 prescribed an NSAID at any Veterans Affairs (VA) 
      facility were identified using prescription fill data and their records linked to 
      a merged VA-Medicare database. Each person-day was assessed for NSAID, coxib or 
      proton pump inhibitor (PPI) exposure. Incidence density ratios and hazard rates 
      of death were calculated following UGIE, MI and CVA adjusting for demographics, 
      co-morbidity, prescription channeling, geographic location and pharmacological 
      covariates. RESULTS: Among 474 495 patients [97.8% male; 85.3% white; 73.9 years 
      (s.d. 5.6)], death followed at a rate of 5.5 per 1000 person-years (95% CI: 
      5.4-5.6) post-UGIE, 17.7 per 1000 person-years (95% CI: 17.5-17.9) post-MI and 
      21.8 per 1000 person-years (95% CI: 21.6-22.0) post-CVA. CVA was associated with 
      greatest risk of death [hazard ratio (HR) 12.4; 95% CI: 10.9-14.3] followed by MI 
      (HR 10.7; 95% CI: 9.2-11.6) and UGIE (HR 3.3; 95% CI: 2.8-3.9). Predictors of 
      mortality were advancing age and co-morbidity, increased use of coxibs and 
      failure to ensure adequate gastroprotection. CONCLUSION: Among elderly veterans 
      with recent NSAID use, an UGIE, MI or CVA is a clinically relevant premorbid 
      event.
FAU - Abraham, N S
AU  - Abraham NS
AD  - Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey VA 
      Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. 
      nabraham@bcm.edu
FAU - Castillo, D L
AU  - Castillo DL
FAU - Hartman, C
AU  - Hartman C
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20080407
PL  - England
TA  - Aliment Pharmacol Ther
JT  - Alimentary pharmacology & therapeutics
JID - 8707234
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Cyclooxygenase 2 Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Cohort Studies
MH  - Cyclooxygenase 2 Inhibitors/adverse effects
MH  - Female
MH  - Gastrointestinal Diseases/chemically induced/*mortality
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/chemically induced/*mortality
MH  - Proton Pump Inhibitors/adverse effects
MH  - Risk Factors
MH  - Stroke/chemically induced/*mortality
MH  - Treatment Outcome
EDAT- 2008/04/10 09:00
MHDA- 2008/12/17 09:00
CRDT- 2008/04/10 09:00
PHST- 2008/04/10 09:00 [pubmed]
PHST- 2008/12/17 09:00 [medline]
PHST- 2008/04/10 09:00 [entrez]
AID - APT3706 [pii]
AID - 10.1111/j.1365-2036.2008.03706.x [doi]
PST - ppublish
SO  - Aliment Pharmacol Ther. 2008 Jul;28(1):97-106. doi: 
      10.1111/j.1365-2036.2008.03706.x. Epub 2008 Apr 7.