NSAIDs cardiovascular disease link revealed

Osteoarthritis patients need to be made aware of the risks posed by these common drugs

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Osteoarthritis patients may want to rethink their non-steroidal anti-inflammatory drugs (NSAIDs) as a new study finds two-thirds of the increased risk of cardiovascular disease is attributable to the drugs. 

While recent research has found patients with osteoarthritis have a higher risk of cardiovascular disease, up until now it has been unclear just how much of that was a result of the commonly-used drugs of osteoarthritis, NSAIDs. 

In an analysis of the health data of 31,000 British Columbia residents, which included 8000 with osteoarthritis, the chances of developing cardiovascular disease were 23% higher among those with the condition compared with the matched control group. 

Cardiovascular disease wasn’t the only concerning association found in the study either, Professor Aslam Anis told audiences at the EULAR Annual European Congress for Rheumatology in Amsterdam last week. 

The University of British Columbia professor also found congestive heart failure was 42% higher among patients with osteoarthritis, ischemic heart disease 17% higher and stroke 14% higher. 

After analysing the data and adjusting for contributing factors such as BMI, gender, age, socioeconomic status and other health comorbidities, Professor Anis and his colleagues found that two-thirds of the cardiovascular disease risk was attributable to NSAIDs. 

NSAIDs were also responsible for almost half of the increased risk of congestive heart failure, and more than 90% of the increased risk of ischemic heart disease and stroke. 

The findings might give clinicians cause to consider other methods of pain relief for these patients, the study author said. 

“Often we find ourselves in the situation where the treatment can be worse than the cure,” Professor Anis told The Medical Republic.  

Because there is no cure for osteoarthritis, people are left trying to manage the symptoms, and NSAIDs have become widely used as a result. 

While these findings supported a greater investment in effective non-NSAID treatments, such as weight-loss, diet and exercise, Profesor Anis acknowledged these lifestyle changes were difficult to implement. 

There could be a role for non-NSAID painkillers, such as paracetamol, and vigilance for signs of cardiovascular disease among these patients, he added.

 Professor Thomas Dörner, the conference’s chairperson of the abstract selection committee, said this was an important study in illuminating the potential causal role that NSAIDs might play in the elevated rates of cardiovascular disease among these patients. 

“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,” Professor Dörner said in a statement. 

According to Professor Anis, this analysis was one of the first longitudinal studies into relationship between the drugs and cardiovascular disease among osteoarthritis patients in a large population-based evaluation.

Nevertheless, he emphasised that this was a retrospective, database analysis, and that more studies were needed to understand the causality and mechanisms behind this link. 

In the meantime, Professor Anis said it was important that patients were also made aware of the possible risks, given the ease with which patients can buy NSAIDs, such as ibuprofen, over-the-counter. 

In response to a question from the audience about the impact of various types of NSAIDs, Professor Anis said that the data appeared to show that drugs such as COX-2 inhibitors had less of an impact on cardiovascular disease than ibuprofen.