Osteoarthritis-related CVD risk tied to NSAID use
More than half of the increase in cardiovascular disease (CVD) risk associated with osteoarthritis can be attributed to the use of nonsteroidal anti-inflammatory drugs (NSAIDs), suggests a study presented at the EULAR 2018 Congress.
“Our results indicate that osteoarthritis is an independent risk factor for CVD and suggest a substantial proportion of the increased risk is due to the use of NSAIDs,” said Professor Aslam Anis from the School of Population and Public Health, University of British Columbia in Vancouver, Canada. “This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis.”
The longitudinal population-based cohort study included 7,743 cases with osteoarthritis who were matched to 23,229 controls without osteoarthritis. The risk of incident CVD, ischaemic heart disease (IHD), congestive heart failure (CHF), and stroke was estimated using multivariable Cox proportional hazards models. Current NSAID use was based on prescription dispensing records. [EULAR 2018, abstract OP0190]
Compared with controls, individuals with osteoarthritis had a 23 percent (adjusted hazard ratio [HR], 1.23, 95 percent confidence interval [CI], 1.17–1.29) increased risk of developing CVD, the primary endpoint, after adjusting for age, sex, socioeconomic status, diabetes, hypertension, hyperlipidaemia, chronic obstructive pulmonary disease, body mass index, and Romano comorbidity score.
Also, the risk of the secondary endpoints of IHD, CHF, and stroke was 42 percent, 17 percent, and 14 percent higher, respectively in cases vs controls.
Several mechanisms were believed to mediate the association between osteoarthritis and increased CVD risk. One of them is the use of NSAIDs in management of osteoarthritis, whereby NSAIDs have also been linked to an increased risk of CVD.
Of the total effect of osteoarthritis on the increase in CVD risk, more than two-thirds (67.5 percent) of the effect was mediated through current NSAID use.
For the secondary outcomes, 44.7 percent of the increase in CHF risk and >90 percent of the increase in IHD and stroke risk in people with osteoarthritis were associated with current NSAID use.
According to Anis, the results were most likely underestimated as the NSAIDs studied were limited to prescription drugs and did not include over-the-counter NSAIDs.
“This study is important because it provides new information about the potential causal role of NSAIDs for the observed cardiovascular complications among individuals with osteoarthritis,” said Professor Thomas Dörner of Charité University Hospitals in Berlin, Germany, who was also the chairperson of the EULAR Abstract Selection Committee.
“To the best of our knowledge, this is the first longitudinal study to evaluate the mediating role of NSAID use in the relationship between osteoarthritis and CVD in a large population‐based sample,” said Anis.
As NSAIDs play an important role in alleviating pain from osteoarthritis, the researchers said currently there is no solution to the problem yet. Doctors are advised to discuss the potential risk of taking NSAIDs with their patients as part of the decision-making process.