NSAIDs heighten CV risk in patients with osteoarthritis

People with osteoarthritis (OA) are 23% more likely to develop CVD than their non-arthritic counterparts if they regularly use non-steroidal anti-inflammatory drugs (NSAIDs), according to research published in Arthritis & Rheumatology August 6.

Senior author Aslam Anis, PhD, and colleagues studied 7,743 OA patients in British Columbia, Canada, in an effort to clarify the role of NSAIDs in the population. While such patients commonly turn to painkillers like ibuprofen, naproxen or aspirin to relieve their joint pain, Anis et al.’s findings have thrown the safety of those drugs into question.

The team’s research included 23,229 controls without OA, all of whom were age- and sex- matched to the study population. Anis and co-authors considered the risk of developing incident CVD as their primary outcome; instances of ischemic heart disease (IHD), congestive heart failure (CHF) and stroke were secondary outcomes.

Using a multivariable Cox proportional hazards model, the investigators determined OA patients were at a 23% increased risk of developing heart disease compared to non-OA controls. About 41% of that increased risk could be attributed to NSAID use.

“Our results indicate that osteoarthritis is an independent risk factor for cardiovascular disease and suggest a substantial proportion of the increased risk is due to the use of NSAIDs,” Anis said in a release. “This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis.”

Painkillers also seemed to play a substantial role in the development of the study’s secondary outcomes. The risks of CHF, IHD and stroke were 42%, 17% and 14% greater in patients with OA, respectively, and the proportion of disease mediated through NSAIDs in those cases were 23%, 56% and 64%, respectively.

“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 cardiovascular disease in a large population-based sample,” Anis said. “It’s important for people with OA to talk to their care providers and discuss the risks and benefits of NSAIDs.”