Evidence map›Paper›PMID 25006185›Full record

Trial reportCirculation. Cardiovascular quality and outcomes2014

Nonsteroidal anti-inflammatory drugs and cardiovascular outcomes in women: results from the women's health initiative.

Anthony A Bavry, Fridtjof Thomas, Matthew Allison, Karen C Johnson, Barbara V Howard, Mark Hlatky, JoAnn E Manson, Marian C Limacher

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation. Cardiovascular quality and outcomes, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00000611 (Women's Health Initiative), which is not on this map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
4.0field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00000611 phase3completednot on this map

Women's Health Initiative (WHI)

TypeinterventionalSponsorNational Heart, Lung, and Blood Institute (NHLBI)ConditionsBone Diseases, Breast Neoplasms, Cardiovascular Diseases, Colonic NeoplasmsArmshormone replacement therapy, estrogens, progestins, estrogen replacement therapy, diet, fat-restricted
3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 23 citations in OpenAlex.

  1. Article
  2. Review
  3. Efficacy of acetaminophenSaudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2019
    Article
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Anthony A BavryFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.). bavryaa@medicine.ufl.edu.
Fridtjof ThomasFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Matthew AllisonFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Karen C JohnsonFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Barbara V HowardFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Mark HlatkyFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
JoAnn E MansonFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Marian C LimacherFrom the North Florida/South Georgia Veterans Health System, Gainesville, FL (A.A.B); Division of Cardiovascular Medicine, University of Florida, Gainesville (A.A.B., M.C.L.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (F.T., K.C.J.); Division of Preventive Medicine, University of California, San Diego, La Jolla (M.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Health Research and Policy/Cardiovascular Medicine, Stanford University, CA (M.H.); and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
University of Florida · USNorth Florida/South Georgia Veterans Health System · USUniversity of California, San Diego · USStanford University · US

Funding

CLIN CTR CLIN TRIAL/OBSERVATIONAL STUDY OF WHIN01WH042129 · WH · UNIVERSITY OF FLORIDA · PI LIMACHER, MARIAN C. · 1994 to 2000
$868k
NHLBI NIH HHS HHSN268201100002INHLBI NIH HHS HHSN268201100003INHLBI NIH HHS HHSN268201100004INHLBI NIH HHS HHSN268201100046CPHS HHS HSN268201100001CWHI NIH HHS HHSN268201100002CWHI NIH HHS HHSN268201100003CWHI NIH HHS HHSN268201100004CWHI NIH HHS N01 WH042129
6 · The paper itself

Abstract

backgroundConclusive data about cardiovascular toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) are sparse. We hypothesized that regular NSAID use is associated with increased risk for cardiovascular events in postmenopausal women, and that this association is stronger with greater cyclooxygenase (cox)-2 when compared with cox-1 inhibition. METHODS AND

resultsPostmenopausal women enrolled in the Women's Health Initiative were classified as regular users or nonusers of nonaspirin NSAIDs. Cox regression examined NSAID use as a time-varying covariate and its association with the primary outcome of total cardiovascular disease defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary analyses considered the association of selective cox-2 inhibitors (eg, celecoxib), nonselective agents with cox-2>cox-1 inhibition (eg, naproxen), and nonselective agents with cox-1>cox-2 inhibition (eg, ibuprofen) with the primary outcome. Overall, 160 801 participants were available for analysis (mean follow-up, 11.2 years). Regular NSAID use at some point in time was reported by 53 142 participants. Regular NSAID use was associated with an increased hazard for cardiovascular events versus no NSAID use (hazard ratio [HR], 1.10; 95% confidence interval, 1.06-1.15; P<0.001). Selective cox-2 inhibitors were associated with a modest increased hazard for cardiovascular events (hazard ratio, 1.13; 1.04-1.23; P=0.004 and celecoxib only: HR, 1.13; 1.01-1.27; P=0.031). Among aspirin users, concomitant selective cox-2 inhibitor use was no longer associated with increased hazard for cardiovascular events. There was an increased risk for agents with cox-2>cox-1 inhibition (HR, 1.17; 1.10-1.24; P<0.001 and naproxen only: HR, 1.22; 1.12-1.34; P<0.001). This harmful association remained among concomitant aspirin users. We did not observe a risk elevation for agents with cox-1>cox-2 inhibition (HR, 1.01; 0.95-1.07; P=0.884 and ibuprofen only: HR, 1.00; 0.93-1.07; P=0.996).

conclusionsRegular use of selective cox-2 inhibitors and nonselective NSAIDs with cox-2>cox-1 inhibition showed a modestly increased hazard for cardiovascular events. Nonselective agents with cox-1>cox-2 inhibition were not associated with increased cardiovascular risk. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT00000611.

Indexed as

Women's HealthAgedAnti-Inflammatory Agents, Non-SteroidalCardiovascular DiseasesFemaleFollow-Up StudiesHumansIncidenceMiddle AgedRetrospective StudiesRisk FactorsTreatment OutcomeUnited StatesAnti-Inflammatory Agents, Non-Steroidalanti-inflammatory agents, non-steroidalcoronary artery diseasemyocardial infarctionstroke

Identifiers

PMID25006185
PMCPMC4151243
OpenAlexW2170622194

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.