NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease

Am J Med. 2014 Jan;127(1):53-60.e1. doi: 10.1016/j.amjmed.2013.08.017. Epub 2013 Nov 23.

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.

Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of interest included multivariate adjusted: cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations; cardiovascular death/myocardial infarction/stroke; hospitalization for heart failure; and individual components of the composite end points.

Results: Compared with NSAID nonusers (n = 39,675), NSAID users (n = 4420) were older (70 vs 68 years), more frequently female and white, and had more baseline heart failure and atherosclerotic risk factors (hypertension, dyslipidemia, diabetes, reduced creatinine clearance) (all P < .001). NSAID use was associated with an increased hazard for cardiovascular death/myocardial infarction/stroke/ischemic hospitalizations (adjusted hazard ratio [adj. HR] 1.12; 95% confidence interval [CI], 1.04-1.21; P = .003) and for cardiovascular death/myocardial infarction/stroke (adj. HR 1.16; 95% CI, 1.03-1.30; P = .02). There also was a higher risk of myocardial infarction (adj. HR 1.37; 95% CI, 1.12-1.68; P = .002), stroke (adj. HR 1.21; 95% CI, 1.00-1.45; P = .048), heart failure hospitalizations (adj. HR 1.18; 95% CI, 1.03-1.34; P = .013), and ischemic hospitalizations (adj. HR 1.17; 95% CI, 1.07-1.27; P = .001).

Conclusion: Among patients with stable atherothrombosis, NSAID use is associated with a higher risk of myocardial infarction, stroke, and hospitalizations for both ischemia and heart failure.

Keywords: Heart failure; NSAID; Outcomes; Stable atherothrombosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Arteriosclerosis / complications*
  • Atherosclerosis / complications
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology*
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / mortality
  • Myocardial Ischemia / epidemiology*
  • Myocardial Ischemia / etiology
  • Myocardial Ischemia / mortality
  • Odds Ratio
  • Outpatients / statistics & numerical data*
  • Proportional Hazards Models
  • Registries
  • Risk Assessment
  • Risk Factors
  • Stroke / epidemiology
  • Thrombosis / complications*

Substances

  • Anti-Inflammatory Agents, Non-Steroidal