NSAIDs Increase Cardiovascular Risk in Osteoarthritis

Ingrid Hein

June 15, 2018

AMSTERDAM — For patients with osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for cardiovascular disease to more than twice the rate of the general population, new research shows.

"There's no cure for people with osteoarthritis, and you have to treat the pain. But when you treat it with NSAIDs, you increase cardiovascular risk," said Aslam Anis, PhD, from the University of British Columbia in Vancouver, Canada.

NSAIDs are commonly used to treat the stiff joints that osteoarthritis patients experience, especially in the morning. Thinning of the cartilage in joints causes bones to rub against each other, leading to the common symptoms of joint swelling and pain.

We don't have solutions.

"It's one of those situations when the treatment can be just as bad as the problem," Anis told Medscape Medical News. "We don't have solutions."

Osteoarthritis has already been shown to be an independent risk factor for cardiovascular disease (Sci Rep. 2016;6:39672), but Anis and his colleagues wanted to "disentangle" the role of NSAIDs in this association.

The team identified 7743 people with osteoarthritis and an age- and sex-matched cohort of 23,229 people without osteoarthritis from 720,055 administrative health records in British Columbia.

"Healthcare is free in Canada, so everything is centralized," Anis explained here at the European League Against Rheumatism Congress 2018.

With multivariable Cox proportional hazards models, risk for the primary outcome of cardiovascular disease was estimated to be 23% higher in people with osteoarthritis than in those without after adjustment for age, sex, socioeconomic status, body mass index, hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, and Romano comorbidity score.

For secondary outcomes, risk for congestive heart failure was 42% higher in people with osteoarthritis, for ischemic heart disease risk was 17% higher, and for stroke risk was 14% higher.

When prescription dispensing records for current NSAID use were linked to the healthcare database, approximately 67.5% of the total effect of osteoarthritis on cardiovascular disease risk was related to NSAID use.

Specifically, the risk for congestive heart failure increased by 44.8% with NSAID use, the risk for ischemic heart disease increased by 94.5%, and the risk for stroke increased by 93.3%.

These results are likely conservative, because the records only captured prescription NSAIDs; the effect of over-the-counter NSAIDs, such as ibuprofen and naproxen, were not accounted for.

"We would have to involve pharmacists to capture that information, and that would likely amplify the results," Anis explained.

However, the significant role NSAIDs play in cardiovascular disease risk "is a big problem," he said. "And I don't have an answer on how to solve it."

Do you want to live with pain or live longer?

"You haven't got much of a chance without NSAIDs if you want to take away the pain," said Georg Gauler, MD, from Osnabrück, Germany.

The drugs are indispensable in his daily practice, he told Medscape Medical News. Although he warns patients to be careful because NSAIDs can have adverse effects on the kidney and heart, they take them anyway "because it helps," he said.

You have to discuss the risks with your patient, Gauler explained. "Do you want to live with pain or live longer?"

Joint replacement can be an option for some patients, but "otherwise, stick to the pills," he said.

Anis and Gauler have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2018: Abstract OP0190. Presented June 14, 2018.

Follow Medscape on Twitter @Medscape and Ingrid Hein @ingridhein

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