NSAIDs a Key Culprit in Cardiovascular Risk in Osteoarthritis

June 18, 2018

A substantial proportion of the increased cardiovascular risk in patients with OA can be attributed to these commonly used drugs.

More than two-thirds of the increased cardiovascular risk associated with osteoarthritis is linked to the use of nonsteroidal anti-inflammatory drugs (NSAIDs), according to Canadian researchers. They presented their results at the Annual European Congress of Rheumatology (EULAR 2018) on June 13 in Amsterdam, The Netherlands.

“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, Chairperson of the Abstract Selection Committee, EULAR.

Recent research suggests that osteoarthritis is an independent risk factor for cardiovascular disease (CVD), and several mechanisms have been proposed to account for this association. One of these is the frequent use of NSAIDs in the treatment of osteoarthritis because they have been shown to be a proven risk factor for CVD.

“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 study author Professor Aslam Anis, School of Population and Public Health, University of British Columbia in Vancouver. “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.”

Results of the study demonstrate that people with osteoarthritis had a 23% higher risk of developing CVD. The increased risk of congestive heart failure (CHF), ischemic heart disease (IHD), and stroke was 42%, 17%, and 14%, respectively. Investigators then calculated the impact of NSAID use on the increased risk and found that 68% of the total effect of osteoarthritis on CVD risk was due to NSAID use. The proportion of the increased risk due to NSAIDs seen in CHF was calculated at 45% and more than 90% for IHD and stroke, respectively.

This population-based cohort study used data from 7743 osteoarthritis patients and 23,229 non-osteoarthritis controls matched for age and gender from health administrative data from British Columbia, Canada. Statistical analysis was used which adjusted the results for age, gender, socioeconomic status, body mass index, and several conditions known to be associated with CVD, such as chronic obstructive pulmonary disease, hypertension, diabetes, elevated cholesterol, and Romano comorbidity score.

References:

Atiquzzaman M, Kopec J, Karim E, et al. The role of NSAIDs in the association between osteoarthritis and cardiovascular diseases: a population-based cohort study. Presented at: EULAR 2018; 13-16 June 2018; Amsterdam, The Netherlands. Abstract OP0190.