Risk of ischaemic heart disease stratified by NSAID exposure in patients with AS compared with controls
| Exposure to NSAIDs | Total | Men | Female | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of subjects | Number of IHD events | Fully adj HR | 95% CI | Number of subjects | Number of IHD events | Fully adj HR | 95% CI | Number of subjects | Number of IHD events | Fully adj HR | 95% CI | |
| Controls (n=25 299) | Reference | Reference | Reference | |||||||||
| No NSAIDs | 902 | 541 | 856 | 455 | 7046 | 86 | ||||||
| Any NSAID | 1391 | 59 | 923 | 42 | 474 | 17 | ||||||
| Naproxen | 438 | 9 | 294 | 7 | 144 | 2 | ||||||
| COX-2 inhibitors | 89 | 8 | 48 | 4 | 41 | 4 | ||||||
| Other NSAIDs 899 | 42 | 599 | 31 | 300 | 11 | |||||||
| AS (n=3640) | ||||||||||||
| Any NSAID* | ||||||||||||
| No | 2407 | 59 | 1.01 | (0.77 to 1.32) | 1660 | 42 | 0.85 | (0.62 to 1.16) | 747 | 17 | 1.50 | (0.89 to 2.53) |
| Yes | 1233 | 43 | 1.36 | (1.00 to 1.85) | 893 | 34 | 1.35 | (0.95 to 1.92) | 340 | 9 | 1.68 | (0.84 to 0.334) |
| Naproxen† | ||||||||||||
| No | 3349 | 101 | 1.10 | (0.88 to 1.37) | 2347 | 75 | 1.02 | (0.79 to 1.31) | 1002 | 26 | 1.47 | (0.94 to 2.32) |
| Yes | 291 | 1 | 0.26 | (0.04 to 1.84) | 206 | 1 | 0.29 | (0.04 to 2.05) | 85 | 0 | – | – |
| COX-2 inhibitors‡ | ||||||||||||
| No | 3353 | 92 | 1.10 | (0.82 to 1.29) | 2351 | 68 | 0.94 | (0.72 to 1.22) | 1002 | 24 | 1.45 | (0.91 to 2.30) |
| Yes | 287 | 10 | 3.03 | (1.61 to 5.69) | 202 | 8 | 3.11 | (1.54 to 6.29) | 85 | 2 | 1.98 | (1.34 to 2.92) |
| Other NSAIDs§ | ||||||||||||
| No | 2948 | 70 | 0.98 | (0.77 to 1.27) | 2039 | 51 | 0.89 | (0.66 to 1.19) | 909 | 19 | 1.46 | (0.88 to 2.41) |
| Yes | 692 | 32 | 1.32 | (0.93 to 1.89) | 514 | 25 | 1.27 | (0.85 to 1.90) | 178 | 7 | 1.55 | (0.71 to 3.37) |
Bold typeface indicates statistical significance (p<0.05). Patients with AS with or without recent NSAID use were compared with all controls, irrespective of the use of NSAIDs in the control group. The controls are the reference group with an HR of 1.0.
*HR adjusted for: age, gender, as well as smoking status, BMI and use of antihypertensives, antiplatelets, antidiabetics, statins in the past 6 months.
†HR adjusted for: age, gender, use of COX-II inhibitors and other traditional NSAIDs other than naproxen in the previous 3 months, as well as smoking status, BMI and use of antihypertensives, antiplatelets, antidiabetics, statins in the past 6 months.
‡HR adjusted for: age, gender, use naproxen and other traditional NSAIDs in the previous 3 months, as well as smoking status, BMI and use of antihypertensives, antiplatelets, antidiabetics, statins in the past 6 months.
§HR adjusted for: age, gender, use of naproxen and COX-II inhibitors in the previous 3 months, as well as smoking status, BMI and use of antihypertensives, antiplatelets, antidiabetics, statins in the past 6 months.
AS, ankylosing spondylitis; adj, adjusted; BMI, body mass index; COX-2 inhibitors, cyclo-oxygenase-2 inhibitor; IHD, ischaemic heart disease; NSAID, non-steroidal anti-inflammatory drugs.