Older patients with hypertension and coronary artery disease who use NSAIDs for chronic pain are at significantly increased risk of cardiovascular events, a new analysis shows.
An observational study found in a cohort of more than 22,000 patients, with a mean age of 66.1, chronic NSAID use was associated with a 47% increased risk of cardiovascular events compared to non-users.
The trial was conducted with data from the hypertension trial INVEST, a trial comparing treatment with and without a calcium channel blocker in patients with hypertension and coronary artery disease.
Researchers asked each patient about their use if NSAIDs at every follow-up visit and patients who reported NSAID use at every visit were identified as chronic users, while all others were identified as non-chronic users.
After a mean follow-up of 2.7 years the researchers compared the 882 chronic NSAID users with the 14,408 non-users.
The primary outcome of all-cause death, non-fatal myocardial infarction or non-fatal stroke occurred at a rate of 4.4 events per 100 patient-years in chronic NSAID users and 3.7 events per 100 patient-years in non-chronic NSAID users, a 47% increased relative risk due largely to a 2.3-fold increase in the risk of cardiovascular mortality.
Lead author Dr Anthony Bavry, a cardiologist at the University of Florida, concluded: ‘Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up.'
Dr Barry said: ‘We found a significant increase in adverse cardiovascular outcomes, primarily driven by an increase in cardiovascular mortality. This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern.
‘When I see patients like these… I try to get them to switch to an alternative agent, such as paracetamol, or if that's not possible I at least try to get them to reduce the dose of NSAID or the frequency of dosing. But ultimately it's up to them if this potential risk is worth taking.'
Am J Med. 2011 Jul;124(7):614-20.