Vancouver, BC—The use of nonsteroidal anti-inflammatory drugs (NSAIDs) accounts for more than two-thirds of the increased cardiovascular risk associated with osteoarthritis, according to a new study.

A presentation at the Annual European Congress of Rheumatology (EULAR 2018) in Amsterdam points out that osteoarthritis (OA) is an independent risk factor for cardiovascular disease (CVD) but that the risk profile is further clouded because NSAIDS, which are strongly associated with CVD, are frequently used for the treatment of OA.

University of British Columbia–led researchers sought to determine if NSAID use, not OA itself, is the primary link with higher CVD risk. “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 coauthor Aslam Anis, PhD.

“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.”

In conducting the population-based cohort study, researchers used data from 7,743 osteoarthritis patients and 23,229 nonosteoarthritis controls matched for age and gender from Canadian health administrative data. Adjustments were made for a range of factors, including age, gender, socioeconomic status, and body mass index, as well as chronic obstructive pulmonary disease (COPD), high blood pressure, diabetes, high cholesterol, and Romano comorbidity score—conditions and factors known to raise heart disease risks.

Results indicate that OA patients had a 23% higher risk of developing CVD compared with those without the condition, for an adjusted hazard ratio (HR) (95% CI) of 1.23 (1.17, 1.29). In addition, risks for specific cardiovascular conditions were elevated; adjusted HR (95% CI) was 1.42 (1.33, 1.52), 1.17 (1.10, 1.27), and 1.14 (1.08, 1.24) for congestive heart failure (CHF), ischemic heart disease (IHD), and stroke, respectively.

Study authors calculated that about 67.51% of the total effect of OA on the increased risk of CVD was related to current NSAID use. With the secondary outcomes, the study estimated that about 44.77% of increased CHF risk was tied to the medications, but that more than 90% of the total effects on IHD and stroke were linked to current NSAID use.

“Our study is the first to evaluate the mediating role of NSAID use in the OA-CVD relationship based on population-based health administrative data,” the researchers note. “The results of this study also indicate that OA is an independent risk factor for CVD. Our findings suggest that the mediating role of NSAID use substantially contributes to the OA-CVD association.”

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