RESEARCH - NSAID use does not appear to be associated with increased cardiovascular mortality in patients with inflammatory polyarthritis

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Ann Rheum Dis. Published Online First: 13 April 2008.

doi:10.1136/ard.2007.076760

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

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Extended Report

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

Nicola Jane Goodson 1*, M Alan Brookhart 2, Deborah P.M. Symmons 3,

Alan J Silman 3 and H 4

1 Liverpool University, United Kingdom

2 Brigham & Women's Hospital, United States

3 Manchester University, United Kingdom

4 Brigham & Womens Hospital, United States

Abstract

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.

http://ard.bmj.com/cgi/content/abstract/ard.2007.076760v1?papetoc

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