{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T01:26:49Z","timestamp":1783733209840,"version":"3.55.0"},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,8]],"date-time":"2019-02-08T00:00:00Z","timestamp":1549584000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (<jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s), particularly diclofenac and the newer selective cyclooxygenase (<jats:styled-content style=\"fixed-case\">COX<\/jats:styled-content>)\u20102 inhibitors, has accumulated over the last decade. Our objective was to examine whether the use of <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for the use of specific <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Drug utilization study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000\u20132016).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (<jats:styled-content style=\"fixed-case\">DDDs<\/jats:styled-content>)\/1000 inhabitants\/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The <jats:styled-content style=\"fixed-case\">DDD<\/jats:styled-content> is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s increased in all countries and were highest in Iceland, with 74.3 <jats:styled-content style=\"fixed-case\">DDD<\/jats:styled-content>s\/1000 inhabitants\/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content> in Norway, with 63 prescription users\/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 <jats:styled-content style=\"fixed-case\">DDD<\/jats:styled-content>\/1000 inhabitants\/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective <jats:styled-content style=\"fixed-case\">COX<\/jats:styled-content>\u20102 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 <jats:styled-content style=\"fixed-case\">DDD<\/jats:styled-content>\/1000 inhabitants\/day in 2016).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sales and prescription patterns of <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s. However, given existing evidence on the cardiovascular risks associated with the use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over\u2010the\u2010counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2217","type":"journal-article","created":{"date-parts":[[2019,1,13]],"date-time":"2019-01-13T06:44:25Z","timestamp":1547361865000},"page":"150-160","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000\u20132016: A Drug Utilization Study"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6373-1386","authenticated-orcid":false,"given":"Kasper Bruun","family":"Kristensen","sequence":"first","affiliation":[{"name":"Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Karlstad","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Aging Norwegian Institute of Public Health Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaana E.","family":"Martikainen","sequence":"additional","affiliation":[{"name":"Research Unit The Social Insurance Institution (Kela) Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Potteg\u00e5rd","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas W.","family":"Wastesson","sequence":"additional","affiliation":[{"name":"Aging Research Center Karolinska Institutet &amp; Stockholm University Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Zoega","sequence":"additional","affiliation":[{"name":"Centre of Public Health Sciences Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Medicines Policy Research Unit, Centre for Big Data Research in Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Cardiology Regional Hospital West Jutland Herning Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001388"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03261999"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60900-9"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001098"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1909"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61490-7"},{"key":"e_1_2_6_8_1","unstructured":"Food and Drug Administration.Public Health Advisory: FDA Announces Series of Changes to the Class of Marketed Non\u2010Steroidal Anti\u2010Inflammatory Drugs (NSAIDs) 2005. 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