Background The use of NSAIDs is associated with increased cardiovascular (CV) events and death. The NSAID associated CV hazard of different NSIADs may differ: recently it was found highest in diclofenac, and naproxen was found least harmful.1 Most studies on NSAID associated CV risk were done in clinical trial populations, which generally are highly selected.
Objectives to study the cardiovascular (CV) hazard of NSAID treatment in unselected patients, including elderly patients and patients with comorbidities and comedication.
Methods prospective analysis of 3-year data of the Arthritis Center Twente CardioVascular Disease (ACT-CVD) cohort evaluating the association between continuous use of different non-steroidal anti-inflammatory drugs (NSAIDs; naproxen, diclofenac, ibuprofen, meloxicam or COXIB (etoricoxib or celecoxib)) and the occurrence of first CV events in rheumatoid arthritis (RA) and osteoarthritis (OA). The ACT-CVD cohort contains data of unselected patients with new or longstanding rheumatologic diagnoses, and thus represents a daily clinical rheumatology population. COX-regression analysis was adjusted for baseline estimated 10-year CV risk and intermittent NSAID usage.
Results Of 686 patients, 46, 37/552 non-NSAID and 9/134 NSAID users, had experienced a first CV event after a median follow up of 36 months. COX regression analysis showed a significant association between baseline continuous use of ibuprofen (HR 3.59, 95%CI 1.08-11.93) or COXIB (HR 4.86, 95%CI 1.47-16.11) and the occurrence of major CV events.
Conclusions in an unselected population of RA and OA patients the tNSAID ibuprofen and COXIBs were associated with a significant increase in CV event risk after only 3 years follow up.
Coxib and traditional NSAID Trialist's Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013.
Disclosure of Interest : None declared