Editor—Etminan et al present a systematic review and meta-analysis on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of developing subsequent Alzheimer's disease.1 The trials included in the review were observational studies (six cohort and three case-control). While theoretical mechanisms for protection against Alzheimer's disease exist (prevention of senile plaque formation), the authors correctly point out that, currently, no randomised controlled trials have examined the role of NSAIDs in preventing Alzheimer's disease.
As the Women's Health Initiative has shown,2 overstating the findings of observational studies is risky. In light of the lack of evidence from randomised controlled trials, the conclusions by Etminan et al that NSAIDs offer some protection against the development of Alzheimer's disease (in the abstract) and that their results show that use of an NSAID lowers the risk of developing Alzheimer's disease (in the discussion section) are overstated. The authors later correctly note that the appropriate dose, duration, and risk/benefit of NSAID use for protection against Alzheimer's disease are unclear (as well as the appropriate population for a prevention strategy).
Pending randomised controlled trials to address these issues, it is best to note that the use of NSAIDs is associated with a decreased risk of Alzheimer's disease.
Competing interests: None declared.
References
- 1.Etminan M, Gill S, Samii A. Effect of non-steroidal anti-inflammatory drugs on risk of Alzheimer's disease: systematic review and meta-analysis of observational studies. BMJ 2003;327: 128-31. (19 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288: 321-33. [DOI] [PubMed] [Google Scholar]