NSAIDs May Increase Cardiovascular Disease Risk in Osteoarthritis

Nonsteroidal anti-inflammatory drug (NSAID) use contributes substantially to the increased risk of cardiovascular disease among patients with osteoarthritis, say researchers writing in Arthritis & Rheumatology last month.

Research has suggested that osteoarthritis is an independent risk factor for cardiovascular disease, which has a substantial burden in terms of both mortality and health‐related quality of life. While the underlying mechanism of this increased risk of cardiovascular disease among patients with osteoarthritis has not been studied, it is thought that as patients with osteoarthritis frequently take NSAIDs to control their pain and inflammation, the use of NSAIDs may lead to cardiovascular disease.

“Our study is the first to evaluate the mediating role of NSAID use in the association between osteoarthritis and cardiovascular disease based on population‐based health administrative data,” wrote the authors, led by Aslam Anis, Ph.D., of the University of British Columbia in Canada.

The longitudinal observational cohort‐based analysis included 7,743 patients with osteoarthritis and 23,229 age and sex match controls, without osteoarthritis. The risk of developing cardiovascular disease was 23 percent higher among patients with osteoarthritis compared to the controls. For the secondary outcomes, the risk of congestive heart failure, ischemic heart disease and stroke was 42 percent, 17 percent and 14 percent higher, respectively, in patients with osteoarthritis compared with the controls.

Patients with osteoarthritis used more NSAIDs than the controls, and approximately 41 percent of the increased cardiovascular risk among patients with osteoarthritis was mediated through NSAID use. For the secondary outcomes, the proportion of congestive heart failure, ischemic heart disease and stroke mediated through NSAIDs was 23 percent, 56 percent, and 64 percent, respectively.

The findings have huge health implications as pervious studies have shown that more than three quarters of patients with osteoarthritis are treated with NSAIDs.

Still, the researchers noted that they had to create the mediator variable, NSAID use, from prescription claims data that did not include over-the-counter medications, while another limitation of the study involved the method for managing data for people without osteoarthritis who did not have cardiovascular disease, which may have resulted in overestimation of the NSAID mediating effect.

REFERENCE

Mohammad Atiquzzaman, Mohammad E. Karim, Jacek Kopec, et al.“Role of Nonsteroidal Antiinflammatory Drugs in the Association Between Osteoarthritis and Cardiovascular Diseases: A Longitudinal Study.”  Arthritis Rheumatol. August 6, 2019. doi:10.1002/art.41027