Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to control pain and inflammation in people living with osteoarthritis, but a new study published in Arthritis & Rheumatology suggests these drugs may contribute to cardiovascular disease risk in osteoarthritis patients. People living with osteoarthritis are at an increased risk of cardiovascular disease compared to the general population, but the underlying mechanism behind this elevated risk isn’t known. Preliminary research suggests that NSAIDs could play a role.
Dr. Aslam Anis, professor in the faculty of medicine’s school of population and public health (SPPH) and head of the Centre for Health Evaluation & Outcomes Sciences (CHÉOS), SPPH associate professor and CHÉOS scientist Hubert Wong and SPPH assistant professor and CHÉOS scientist Ehsan Karim, along with UBC faculty of pharmaceutical sciences postdoctoral student and CHÉOS trainee Mohammad Atiquzzaman, used provincial administrative data to identify how much of the increase in cardiovascular disease risk related to osteoarthritis is due to NSAID use alone.
“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,” said Anis, senior author of the study.
The study matched 7,743 osteoarthritis patients with 23,229 non-osteoarthritis controls. Comparable to previous research, the risk of developing cardiovascular disease among people in the sample with osteoarthritis was 23 per cent higher than people without osteoarthritis.
“Our results confirm that osteoarthritis is an independent risk factor for cardiovascular disease”
professor, school of population and public health
“Our results confirm that osteoarthritis is an independent risk factor for cardiovascular disease and suggest a substantial proportion of this increased risk in osteoarthritis is due to the use of NSAIDs,” Anis said. The study found that approximately 41 per cent of the increased risk of cardiovascular disease among people with osteoarthritis could be attributed to their use of NSAIDs. This means that nearly half of the extra cardiovascular disease risk seen in people living with osteoarthritis is due to a medication used to treat the disease.
The risks of congestive heart failure, ischaemic heart disease (characterized by reduced blood supply to the heart) and stroke were also higher among people with osteoarthritis in the study. NSAIDs accounted for a substantial portion of this elevated risk, as well.“Our findings are highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis,” said Anis. “It’s important for people with osteoarthritis to talk to their care providers and discuss the risks and benefits of NSAIDs.”
This study is an important population-based assessment of a growing Canadian health problem and could have considerable implications for the way many people with osteoarthritis are treated. Nearly five million Canadians live with osteoarthritis, the majority of whom use NSAIDs to treat their pain — in 2007, approximately 1.2 million NSAID prescriptions were written in Canada to treat people with osteoarthritis.