Ann Rheum Dis doi:10.1136/ard.2007.076760

Non-Steroidal Anti-Inflammatory Drug use does not appear to be associated with increased cardiovascular mortality in patients with inflammatory polyarthritis: Results from a primary care based inception cohort of patients.

  1. Nicola Jane Goodson (ngoodson{at}
  1. Liverpool University, United Kingdom
    1. M Alan Brookhart
    1. Brigham & Women's Hospital, United States
      1. Deborah P.M. Symmons
      1. Manchester University, United Kingdom
        1. Alan J Silman
        1. Manchester University, United Kingdom
          1. Daniel H Solomon
          1. Brigham & Womens Hospital, United States
            • Published Online First 13 April 2008


            Objectives: There is controversy about the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on cardiovascular disease (CVD) mortality. The aim of this study was to explore associations between NSAID use and mortality in patients with inflammatory polyarthritis (IP).

            Subjects & Methods: 923 patients with new onset (IP), recruited to the UK Norfolk Arthritis Register (NOAR) between 1990–1994, were followed up to 2004. Current medication was recorded annually for the first 6 years and then every 2-3 years. Rheumatoid factor (RF) & C-reactive Protein (CRP) were measured. Logistic regression was used to calculate all cause and CVD mortality Odds Ratios (OR) for NSAID use at baseline & during follow up, adjusting for gender and time-varying covariates: RF, CRP, joint counts, smoking, steroid use, DMARD use and other medication use.

            Results: By 2004 there were 203 deaths, 85 due to CVD. At baseline, NSAIDs were used by 66% of patients. In final multivariate models, baseline NSAID use was inversely associated with all cause mortality (OR 0.62 adj (95%CI 0.45, 0.84)) and CVD mortality (OR 0.54 adj (95%CI 0.34, 0.86)). Interval NSAID use had weaker mortality associations: all cause mortality (OR 0.72 adj (95%CI 0.52, 1.00)), CVD mortality HR 0.66adj (95%CI 0.40, 1.08)).

            Conclusion: No excess CVD or all cause mortality was observed in NSAID users in this IP patient cohort. This is at variance with the literature relating to NSAID use in the general population. It is unclear whether this represents unmeasured confounders influencing a physician’s decision to avoid NSAIDs in the treatment of IP.