Duloxetine是一种选择性素5-HT和去甲肾上腺素再摄取抑制剂, 用于肌肉骨骼和其他形式的慢性疼痛。它的双重药理作用可能会增加或降低心血管风险: 肾上腺素能活动可能会增加急性心肌梗塞(AMI) 和中风的风险，但抗血小板活性可能会降低风险。Gabapentin是另一种用于治疗疼痛的非阿片类药物，不认为具有肾上腺素能/抗血小板作用。考虑到当前重视使用非阿片类药物治疗慢性疼痛患者，评估这些药物在高风险患者中产生的心血管风险非常重要。我们在Medicare参保人(年龄在65至89岁之间)中的20%样本中进行了回顾性队列研究，这些参保人患有慢性疼痛，且在2015年至2018年间是duloxetine(n =34,009)或gabapentin(n =233,060)的新用户。我们排除了在研究药物开始时有癌症或其他危及生命的疾病的个体。主要结局是AMI、中风和医院外死亡的组合。我们通过时间相关的倒数权重处理校正共病的差异。在115,668人年的随访期内，2361名患者有复合主要结局；duloxetine的新用户中的发病率为16.7/1000人年，而gabapentin的新用户中的发病率为21.1/1000人年，校正风险比=0.98(95% CI: 0.83, 1.16)。无论是对组合结局的各个组成部分还是对人口统计学和临床特征进行分层分析，结果都类似。总之，在开始使用duloxetine治疗非癌性疼痛的Medicare队列患者中，AMI、中风和医院外死亡的发病率与使用gabapentin治疗者相当。 版权所有©2023 Wolters Kluwer Health, Inc.。

Duloxetine is a serotonin-norepinephrine reuptake inhibitor prescribed for musculoskeletal and other forms of chronic pain. Its dual pharmacologic properties have the potential to either raise or lower cardiovascular risk: adrenergic activity may increase the risk for acute myocardial infarction (AMI) and stroke, but antiplatelet activity may decrease risk. Gabapentin is another nonopioid medication used to treat pain, which is not thought to have adrenergic/antiplatelet effects. With the current emphasis on the use of nonopioid medications to treat patients with chronic pain, assessing cardiovascular risks associated with these medications among high-risk patients is important.We conducted a retrospective cohort study among a 20% sample of Medicare enrollees, aged 65 to 89, with chronic pain who were new users between 2015 and 2018 of either duloxetine (n = 34,009) or gabapentin (n = 233,060). We excluded individuals with cancer or other life-threatening conditions at study drug initiation. The primary outcome was a composite of AMI, stroke, and out-of-hospital mortality. We adjusted for comorbidity differences with time-dependent inverse probability of treatment weighting.During 115,668 person-years of follow-up, 2361 patients had the composite primary outcome; the rate among new users of duloxetine was 16.7/1000 person-years compared with new users of gabapentin (21.1/1000 person-years), adjusted hazard ratio = 0.98 (95% CI: 0.83, 1.16). Results were similar for the individual components of the composite outcome as well as in analyses stratified by demographic and clinical characteristics.In summary, cohort Medicare patients with non-cancer pain beginning treatment with duloxetine had rates of AMI, stroke, and out-of-hospital mortality comparable to those who initiated gabapentin.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.