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Possible NSAID-HRT interaction probed


A population-based epidemiological study has attempted to identifywhether an interaction exists for concomitant use of NSAIDs (excludingaspirin) and hormone replacement therapy in peri- and postmenopausalwomen, and the incidence of myocardial infarction.

Theinvestigation was based on the hypothesis that suppression ofprostacyclin (PGI2) is implicated in the cardiovascular hazard frominhibitors of cyclo-oxygenase-2 (COX-2). Furthermore, oestrogen confersatheroprotection via COX-2-dependent PGI2.

Data werecollected from the General Practice Research Database on all femalesaged 50–84 on 1 January 1997 and who were followed up through thedatabase for four years or until the individual died, reached 85 yearsof age, or was diagnosed with a heart attack or cancer.

Thestudy reported that the odds ratio (OR) of MI in 1,673 individuals and7,005 controls was increased from 0.66 (95% confidence interval0.50–0.88) when taking HRT in the absence of traditional NSAIDs, to1.50 (95% CI 0.85–2.64) when taking the combination of HRT and NSAIDs,resulting in a statistically significant interaction (p<0.002 forthe difference between the OR between the two groups).

Theauthors conclude: “Whether oestrogens confer cardioprotection remainscontroversial. Such a benefit was observed only in perimenopausal womenin the only large randomised trial designed to address this issue – theWHI trial. Should such a benefit exist, these results raise thepossibility that COX inhibitors may undermine the cardioprotectiveeffects of HRT.”

National Electronic Library for Medicines 22/5/2007


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