The study, the biggest of its kind, was led by Professor Julia Hippisley-Cox in the University’s Division of Primary Care. It looked at prescribing patterns for over 9,000 patients aged between 25 and 100 across England, Scotland and Wales. The data came from the QRESEARCH database, run by the University in collaboration with the leading IT software provider EMIS. The online version of the BMJ paper was accessed 42,505 times in the first year after publication. It received 28 rapid responses and was cited 97 times in 2005 and 2006.
At the time there was widespread interest in the cardiovascular safety of COX 2 inhibitors after the withdrawal of Vioxx and several papers were published on the risk associated with these agents. The results have since been replicated in other countries by other academic teams.
Trish Groves, Deputy and Senior Research Editor at the BMJ, said: “Most of the papers in the top 10 provided important new evidence on highly controversial questions that mattered then to patients — and still do”. Several were about the safety and effectiveness of widely used treatments for common conditions, she noted. “These studies provide a broader kind of evidence: by systematically reviewing and summarising the best data out there, or analysing what really happened to large numbers of people in real life over time.”
Professor Julia Hippisley-Cox said “This is excellent news not least for the many thousands of GPs who have contributed to QRESEARCH by freely sharing their data to be used for medical research. We will continue to pioneer research into the real risks and benefits for treatments in primary care to give GPs the best information to improve clinical care for the individual patient.”
Dr David Stables, clinical director of EMIS, said “The ethical and non-commercial use of information makes QRESEARCH a worthwhile project that can make a significant difference to healthcare. We are very grateful to the practices who continue to take part in this project“
The study found that for those prescribed NSAIDS in the three months before the heart attack, the risk increased compared with those who had not taken these drugs in the previous three years. For ibruprofen, the risk increased by almost a quarter (24 per cent) and for diclofenac it rose by more than half (55 per cent)
The newer generation of painkillers — COX-2 inhibitors — were also associated with the increased rates of first-time heart attack. Those prescribed the drugs in the proceeding three months were at 21 per cent higher risk of heart attack if taking celecoxib, and 32 per cent increased risk if taking rofecoxib.
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