Long-term NSAID Use by Seniors Can be Problematic

In January I posted a blog about the safety of non-steroid anti-inflammatory drugs (NSAIDs) that contained a quote from one of the investigators:  “Cardiovascular risk needs to be taken into account when prescribing any non-steroid anti-inflammatory drug.”  There was no evidence that one or other NSAID was safer in this respect than the others.  This has received backing from a study published in July in the American Journal of Medicine.

University of Florida physicians examined data from an international study of treatments for hypertension that had over 22,000 participants.  All the patients had high blood pressure and coronary heart disease, and the study involved taking a calcium-blocking drug, an ACE-inhibitor, or a placebo.  There were 882 patients who reported taking NSAIDs at every follow-up visit, who were considered chronic users; they were compared with 14,408 non-users and 7,286 intermittent users.  The study follow-up averaged 2.2 years.  Most of the NSAID users were taking ibuprofen, naproxen, or celecoxib, but other meds of this class were taken as well.  The primary outcome measured was all-cause death, non-fatal heart attack, or non-fatal stroke.

There were 4.4 primary-outcome events per 100 patient-years in the chronic NSAID users compared to 3.7 events/100 patient-years in the non-users plus intermittent users.  This means that being a chronic NSAID user carries a 1.47-times greater risk of death, heart attack, or stroke than non- or intermittent-users. 

Further analysis showed that this result was primarily driven by more than a doubling in the risk of cardiovascular death in the chronic NSAID user – actually 2.26 times.  High blood pressure was not a factor; the chronic NSAID users had a slightly lower average blood pressure during the follow-up period.

Most of the participants taking NSAIDs in this study were doing so because of symptoms from osteoarthritis, rheumatoid arthritis, or chronic back pain.  Based on these results, such patients should talk with their doctor if they are taking NSAIDs.  They could switch to acetaminophen (Tylenol®), or reduce their NSAID dosage or the frequency of use.  The increased risk of NSAIDs is pretty convincing.