Vancouver, British Columbia—Osteoarthritis (OA) patients tend to be regular users of nonsteroidal anti-inflammatory drugs (NSAIDs) to help control pain and inflammation, but a new study emphasizes that they put themselves at risk for cardiovascular side effects.

The article in Arthritis & Rheumatology study determined that about 41% of the increased risk of cardiovascular disease (CVD) among OA patients was mediated through their NSAID use. The risk of developing cardiovascular disease among people with OA was found to be 23% higher compared to those without.

To reach those conclusions, University of British Columbia–led researchers matched 7,743 OA patients with 23,229 non-OA controls.

“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," explained senior study author Aslam Anis, PhD, of the School of Population and Public Health at the University of British Columbia. “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. This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis.”

The authors recommend that OA patients discuss the risks and benefits of NSAIDs with pharmacists and other care providers.

The longitudinal study was based on linked health administrative data (HAD) from British Columbia, Canada. After adjusting for SES, BMI, hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, and Romano comorbidity score, the study team found the adjusted HR (95% CI) to be 1.23 (1.17, 1.28).

In addition, adjusted HR (95% CI) was 1.42 (1.33, 1.51), 1.17 (1.10, 1.26), 1.14 (1.07, 1.22) for congestive heart failure (CHF), and ischemic heart disease (IHD) and stroke, respectively. Among the secondary outcomes, the proportion mediated through NSAID use was 23%, 56% and 64% for CHF, IHD and stroke, respectively, the researchers report.

“Findings of this first study to evaluate NSAIDs mediating role in OA-CVD relationship suggest that NSAID use substantially contributes to the OA-CVD association,” study authors conclude.

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