Table 23NSAIDs and risk of developing AD

StudySample (n)Followup/EventsExposureCase definitionConfounding adjustmentResults
Arvanitakis et al., 2008169

Religious Orders study
Community cohort (1019)1 to 13 years

209 incident AD
Pill bottles baseline and annuallyNINCDS using CERADAge
Sex
Education
Vascular risk factors
APOE e4
Average of z scores
HR (95% CI) for using vs. not using at baseline:
NSAIDs (not ASA): 1.19 (0.87 to 1.62)
ASA: 0.84 (0.63 to 1.11)

Authors reported that results were similar for cumulative use, but data were not shown
Cornelius et al., 2004170

Kungsholmen
Community cohort (1301)3 to 6 years

164 AD
Self-report and bottles (script) at baseline (1987) and first followup (1991–93), not at second followup (1994–96)DSM IIIRAge
Sex
Underlying disease
Educational level
RR (95% CI):
NSAID only: 0.61 (0.32 to 1.15)
ASA only: 1.34 (0.96 to 1.89)
Either: 1.11(0.81 to 1.52)
Szekely et al., 2008171

Cardiovascular Health Study
Community cohort (3229)Up to 10 years

231 AD
Self-report, pill bottles, annually

Analyzed as cumulative and more than or equal to 2 years or less
NINCDSAge
Sex
Education
APOE e4
Baseline 3MS
HR (95% CI):
NSAIDs: 0.65 (0.41 to 0.88)
ASA: 0.87 (0.65 to 1.16)
This apparent benefit of NSAID use seemed to depend strongly on APOE status, being evident only in people with one or more e4 allele.
According to results: “There was no consistent evidence of greater reduction in risk of AD with lagging of exposure, longer duration of use, or higher doses of NSAIDs,” but no quantitative data were reported.
Breitner et al., 2009172
Adult changes in Thought (ACT)
Community cohort (2736)Up to 12 years (3–12)

356 AD
Pharmacy data and an integration of pharmacy data and self reportNINCDS
DSM IV
Age
Cohort
Race
Sex
Education
APOE
HTN
Diabetes mellitus
BMI
Osteoarthritis
Regular exercise
HR (95% CI) for AD as compared to no/low use of NSAIDs:
Pharmacy data alone
Moderate use: 1.26 (0.97 to 1.65)
Heavy use: 1.57 (1.10 to 2.23)

Pharmacy + self report:
Moderate use: 1.15 (0.85 to 1.57)
Heavy use: 1.55 (1.07 to 2.24)

Abbreviations: 3MS = Modified Mini-Mental State Examination; AD = Alzheimer’s disease; APOE = apolipoprotein E gene; APOE e4; epsilon 4 allele of the apolipoprotein E gene; ASA = acetylsalicylate (aspirin); BMI = body mass index; CERAD = Consortium to Establish a Registry for Alzheimer’s Disease; CI = confidence interval; DSM = Diagnostic and Statistical Manual of Mental Disorders; HR = hazard ratio; HTN = hypertension;; NINCDS-ADRDA = National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer’s Disease and Related Disorders Association; NSAID(s) = non-steroidal anti-inflammatory drug(s); RR = relative risk

From: 3, Results

Cover of Preventing Alzheimer's Disease and Cognitive Decline
Preventing Alzheimer's Disease and Cognitive Decline.
Evidence Reports/Technology Assessments, No. 193.
Williams JW, Plassman BL, Burke J, et al.

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