Abstract
The objective of this case-control study was to investigate the risk of cardiovascular disease (CVD) following non-steroidal anti-inflammatory drug (NSAID) use in patients with ankylosing spondylitis (AS). A total of 10,763 new AS patients were identified from the National Taiwan Health Insurance claims database during the period from 1997 to 2008. In all, 421 AS patients with CVD were recruited as cases, and up to 2-fold as many sex- and age-matched controls were selected. Logistic regression models were used to estimate the odds ratio (OR) between NSAID use and CVD incidence. The medication possession rate (MPR) was used to evaluate NSAID exposure during the study period. AS patients had increased risk of CVD (OR, 1.68; 95% confidence interval (CI), 1.57 to 1.80). Among frequent (MPR≥80%) COX II users, the risks for all types of CVD were ten times lower than those among non-users at 24 months (OR, 0.08; 95% CI, 0.01 to 0.92). Among frequent NSAID users, the risks of major adverse cardiac event (MACE) were significantly lower at 12 months (OR, 0.23; 95% CI, 0.07 to 0.76)—a trend showing that longer exposure correlated with lower risk. Regarding non-frequent NSAID users (MPR<80%), short-term exposure did carry higher risk (for 6 months: OR, 1.41; 95% CI, 1.07 to 1.86), but after 12 months, the risk no longer existed. We conclude that long-term frequent use of NSAIDs might protect AS patients from CVD; however, NSAIDs still carried higher short-term risk in the non-frequent users.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world
Data from clinical trials [8,9,10], epidemiological studies [11,12] and a meta-analysis [13] indicated that both traditional NSAIDs and cyclooxygenase II (COX II) inhibitors increase the occurrence of cardiovascular events
Panic has spread to both patients and physicians, certain publications advocate that even a low event rate must be taken seriously, given that NSAIDs are prescribed primarily for symptom relief
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world. Data from clinical trials [8,9,10], epidemiological studies [11,12] and a meta-analysis [13] indicated that both traditional NSAIDs and COX II inhibitors increase the occurrence of cardiovascular events. It is well known that autoimmune/auto-inflammatory diseases are associated with an increased risk of cardiovascular disease (CVD) [15,16]. Given that an inflammatory process mediates atherosclerosis, it has been suggested that the medications used to control inflammation may potentially reduce the cardiovascular risk of autoimmune/auto-inflammatory diseases. Bili et al found that the use of anti-TNF was associated with a 55% reduction in the risk of developing coronary artery disease in an incident cohort of RA patients and that this risk decreased further with prolonged use [26]
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