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More than two-thirds of CVD risk in OA linked to NSAID use
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AMSTERDAM — Approximately 67% of the elevated risk for cardiovascular disease associated with patients with osteoarthritis were attributed to the use of NSAIDs, according to findings presented at the EULAR Annual Congress.
“The examination of cardiovascular risk among individuals with osteoarthritis is an important area of research as very little is known about the association, despite osteoarthritis being the most common rheumatic disease with high prevalence among the elderly,” Thomas Dörner, MD, professor of rheumatology at Charite-Universitätsmedizin, Berlin, said in a press release.
According to Aslam Anis, PhD, director of the Centre for Health Evaluation and Outcome Sciences at the University of British Columbia, Vancouver, Canada, and colleagues, although prior studies have established OA as an independent risk factor for cardiovascular disease (CVD), this association is may be exacerbated by treatment with NSAIDs, which also exhibit increased CVD risk.
To determine the role of NSAIDs in the elevated risk of CVD among patients with OA, the researchers examined health administrative data from 720,055 people in British Columbia to compare patients with OA (n=7,743) with matched age/gender individuals without OA (n=23,229).
Anis and colleagues used multivariable Cox proportional hazards models to estimate the risk for incident CVD, as well as secondary outcomes of ischemic heart disease, congestive heart failure (CHF) and stroke. The researchers estimated the effect of NSAIDs on the relationship between OA and CVD through a marginal structural model.
According to study results, patients with OA exhibited a 23% greater risk for CVD compared with individuals without OA, after adjusting for socioeconomic status, BMI and conditions linked to CVD, including chronic obstructive pulmonary disease, hypertension, diabetes, hyperlipidemia and Romano comorbidity score.
However, when researchers calculated the effect of NSAID use on increased CVD risk associated with OA, they determined that 67.51% of the total effect of OA on CVD risk was attributed to NSAID use. In addition, the researchers noted that 44.77% of the observed increased CHF risk was attributed to NSAID use, while the proportion of the increased risk due to NSAIDs was 44.77% for CHF. More than 90% of the total effects for ischemic heart disease and stroke was attributed to NSAID use.
“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,” Anis said in the release. “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. This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis.”– by Bob Stott
Reference:
Atiquzzaman M, et al. Abstract # OP0190. EULAR Annual Congress; June 13-17, 2018; Amsterdam.
Disclosure: Anis reports no relevant financial disclosures.