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Background

Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs). Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI) hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence.

Methods

We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications.

Results

8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval), for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56) and 3.35 (2.50, 4.47), respectively, and significantly greater for parenteral than oral drugs (p for interaction < 0.01). Ketorolac was associated with the highest AMI risk among both of oral and parenteral NSAIDs studied, the aORs were 2.02 (1.00, 4.09) and 4.27 (2.90, 6.29) respectively. Use of oral flurbiprofen, ibuprofen, sulindac, diclofenac, and parenteral ketoprofen were also significantly associated with increased AMI risk. The results of the present study were consistent with the majority of evidence from previous studies.

Conclusions

The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.  相似文献
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为揭示中国水资源的时空分布格局,引入降水量、干燥度、蒸散发、坡度、植被覆盖度、集水区等6个因素,结合分区权重赋值法,提出了一种改进的对中国水资源空间分配模型。结果表明:基于二级流域的改进水资源空间分配模型对我国具有较高的适用性,其中在三级流域和省级行政单元上的空间分配总体误差分别为7.89%和7.25%。相比黄河流域、淮河流域和西北诸河流域,长江流域、松花江流域和东南诸河流域的水资源空间分配精度更优,其原因在于该区域的水资源空间分布受自然因素(降水量、蒸散发等)影响更为显著。中国水资源空间分布从西北到东南呈增长趋势,这与降水的空间格局基本吻合。南方诸河流域的水资源量主要来源于降水,而冰川融水则是西北诸河流域及多数内陆河流域的主要水源。水资源与国内生产总值(GDP)密度之间的关系随城市规模和地理位置发生变化。这些可为区域水资源管理提供科学依据和数据依据。  相似文献
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