NSAID use in elderly with hypertension linked to increased cardiac risk
MedWire News: Chronic nonsteroidal anti-inflammatory (NSAID) drug use among elderly hypertensive patients with coronary artery disease (CAD) leads to increased mortality, myocardial infarction (MI), and stroke, research suggests.
"This association did not appear to be due to elevated blood pressure because chronic NSAID users actually had slightly lower on-treatment blood pressure over a mean of 2.7 years of follow-up [than nonchronic users]," write Anthony Bavry (University of Florida, Gainesville, USA) and colleagues in the American Journal of Medicine.
The study involved 22,576 hypertensive CAD patients from the International Verapamil Trandolapril Study (INVEST), who self-reported NSAID use at baseline and at follow-up visits conducted every 6 weeks for the first 6 months, and then biannually until 2 years after the last patient was enrolled.
Patients who reported NSAID use at baseline and every follow-up visit were defined as chronic NSAID users, and patients who never took NSAIDs, or reported use at only some visits were defined as nonchronic users (never and intermittent, respectively).
In all, there were 882 chronic NSAID users with a mean age of 65.3 years, and 21,694 nonchronic NSAID users with a mean age of 66.1 years, including 14,408 'never' and 7286 'intermittent' users. The primary outcome of interest was the composite of all-cause mortality, nonfatal MI, and nonfatal stroke.
Multivariate analysis adjusted for baseline characteristics including age, race/ethnicity, and body mass index, revealed that chronic NSAID users were 47% more likely to reach the composite endpoint than nonchronic users (4.4 events per 100 patient-years vs 3.7 events per 100 patient-years, p=0.0003).
This was due to a 2.26-fold increase in cardiovascular mortality among chronic NSAID users compared with nonchronic users (p<0.0001), explain the authors.
In addition, propensity-matched analysis confirmed these findings, revealing that chronic NSAID users had a 60% increased risk for the composite of mortality, MI, and stroke when compared with nonchronic users (p=0.0023).
"Until further data are available, alternative modes of pain relief should be considered for these patients," conclude Bavry et al.
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By Piriya Mahendra