Effect of non-steroidal anti-inflammatory drugs on risk of Alzheimer's disease: systematic review and meta-analysis of observational studies.
Journal: 2003/July - British Medical Journal
ISSN: 1756-1833
Abstract:
OBJECTIVE
To quantify the risk of Alzheimer's disease in users of all non-steroidal anti-inflammatory drugs (NSAIDs) and users of aspirin and to determine any influence of duration of use.
METHODS
Systematic review and meta-analysis of observational studies published between 1966 and October 2002 that examined the role of NSAID use in preventing Alzheimer's disease. Studies identified through Medline, Embase, International Pharmaceutical Abstracts, and the Cochrane Library.
RESULTS
Nine studies looked at all NSAIDs in adults aged>> 55 years. Six were cohort studies (total of 13 211 participants), and three were case-control studies (1443 participants). The pooled relative risk of Alzheimer's disease among users of NSAIDs was 0.72 (95% confidence interval 0.56 to 0.94). The risk was 0.95 (0.70 to 1.29) among short term users (< 1 month) and 0.83 (0.65 to 1.06) and 0.27 (0.13 to 0.58) among intermediate term (mostly < 24 months) and long term (mostly>> 24 months) users, respectively. The pooled relative risk in the eight studies of aspirin users was 0.87 (0.70 to 1.07).
CONCLUSIONS
NSAIDs offer some protection against the development of Alzheimer's disease. The appropriate dosage and duration of drug use and the ratios of risk to benefit are still unclear.
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BMJ 327(7407): 128

Effect of non-steroidal anti-inflammatory drugs on risk of Alzheimer's disease: systematic review and meta-analysis of observational studies

Department of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada H3A 1A1
Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Department of Health Policy, Management and Evaluation, University of Toronto, Canada M6A 2E1
Department of Neurology, University of Washington, Seattle, Washington 98195, USA
Correspondence to: M Etminan ac.lligcm.liam@nanimte.rayham
Correspondence to: M Etminan ac.lligcm.liam@nanimte.rayham
Accepted 2003 May 6.

Abstract

Objectives To quantify the risk of Alzheimer's disease in users of all non-steroidal anti-inflammatory drugs (NSAIDs) and users of aspirin and to determine any influence of duration of use.

Design Systematic review and meta-analysis of observational studies published between 1966 and October 2002 that examined the role of NSAID use in preventing Alzheimer's disease. Studies identified through Medline, Embase, International Pharmaceutical Abstracts, and the Cochrane Library.

Results Nine studies looked at all NSAIDs in adults aged > 55 years. Six were cohort studies (total of 13 211 participants), and three were case-control studies (1443 participants). The pooled relative risk of Alzheimer's disease among users of NSAIDs was 0.72 (95% confidence interval 0.56 to 0.94). The risk was 0.95 (0.70 to 1.29) among short term users (< 1 month) and 0.83 (0.65 to 1.06) and 0.27 (0.13 to 0.58) among intermediate term (mostly < 24 months) and long term (mostly > 24 months) users, respectively. The pooled relative risk in the eight studies of aspirin users was 0.87 (0.70 to 1.07).

Conclusions NSAIDs offer some protection against the development of Alzheimer's disease. The appropriate dosage and duration of drug use and the ratios of risk to benefit are still unclear.

Abstract

NS=not stated, all older adults. APOE=apolipoprotein E. Mean age. †Folstein mini-mental state examination.

WW II=second world war. Mean age. †Only data on aspirin used from this study. ‡Canadian study of health and ageing.

Notes

We thank Paula Rochon (Kunin-Lunenfeld Applied Research Unit and Department of Health Policy, Management and Evaluation, University of Toronto, Canada) for reviewing the manuscript.

Contributors: ME and AS initiated the project. ME, SG, and AS screened and extracted the data. ME and SG analysed the data. All authors participated in discussing the results and in writing the paper. ME will act as guarantor for the paper.

Funding: AS is funded by a Parkinson Disease Research Education and Clinical Center (PADRECC) grant. ME and SG are funded by Canadian Institutes of Health Research (CIHR) postdoctoral fellowship awards. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

Competing interests: None declared.

Notes
We thank Paula Rochon (Kunin-Lunenfeld Applied Research Unit and Department of Health Policy, Management and Evaluation, University of Toronto, Canada) for reviewing the manuscript.
Contributors: ME and AS initiated the project. ME, SG, and AS screened and extracted the data. ME and SG analysed the data. All authors participated in discussing the results and in writing the paper. ME will act as guarantor for the paper.
Funding: AS is funded by a Parkinson Disease Research Education and Clinical Center (PADRECC) grant. ME and SG are funded by Canadian Institutes of Health Research (CIHR) postdoctoral fellowship awards. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.
Competing interests: None declared.

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