Millions of Americans live with the pain and inflammation caused by osteoarthritis and many find relief by taking nonsteroidal anti-inflammatory (NSAID) drugs.
Whether prescription strength or over the counter, these drugs can decrease pain and fever and prevent blood clots. In higher doses, they can also decrease inflammation.
But the benefits of this class of drugs do not come without a price.
NSAID side effects carry an increased risk of ulcers, bleeding, heart attack and kidney disease. Now, a study shows NSAIDs may be to blame for an increase in cardiovascular disease in people with osteoarthritis. The study published in Arthritis & Rheumatology directly examined the relationship between osteoarthritis and cardiovascular disease patients.
Researchers at University of British Columbia in Vancouver conducted the study which found people with osteoarthritis had a 23% higher risk of cardiovascular disease after adjusting for factors like body mass, high blood pressure and cholesterol, diabetes and socioeconomic status. Results show they also had a 42% higher risk of congestive heart failure, 17% higher risk of ischemic heart disease and 14% higher risk of stroke.
The question is whether NSAID use played a role in these numbers. Researchers found NSAID use was five times more common among people with osteoarthritis.
Researchers also found NSAIDs alone did cause an increased risk of cardiovascular disease.
The numbers were even higher for stroke showing NSAIDS contributed to 64% of the increase in risk. The study also concludes the drug contributed to 56% of the increased risk of ischemic heart disease.
The data used in the study was taken from prescription claims and did not include information on over-the-counter NSAID use. It also did not take into account factors such as family history, smoking or physical activity. The numbers did show obesity, high blood pressure and chronic obstructive pulmonary disorder were more commong among those with osteoarthritis.
The results come as no surprise to Dr. J. Travis Wilson, a cardiologist with Allegheny Health Network whose practice is based at Canonsburg Hospital.
“We’ve always viewed NSAIDs as relatively contraindicated for patients with heart failure,” he said. “In the setting of true heart failure, your kidneys are vulnerable and some of the pathways that NSAIDs work on can affect your kidneys’ ability to kind of help your body handle heart failure.”
Wilson said heart blockage all comes down to inflammation.
“The buildup of blockages in the arteries on top of the heart (atherosclerotic disease) ultimately is due to having an inappropriate inflammatory response,” he said. “And most plaques or blockages in the vessels start by some sort of insult to the wall of the artery.”
Wilson said an example of two people who both have some sort of “insult” to the vessel wall. One person may simply just have a little bit of what he called a “fatty streak” and not much of a blockage at all and one patient stays stable over the next decade, while the other develops a 90% blockage.
“We don’t fully understand what are the differences between Person A and Person B in that scenario,” Wilson said. “But one thing that we have come to understand is that clearly, Person B mounts much more of a robust inflammatory response to that insult to the vessel wall.”
Osteoarthritis is also an inflammatory response to irritation in joints and deterioration of cartilage.
“You can lay out the same scenario that person A has some sort of trauma and 10 years later is running marathons,” he said. “Person B 10 years later is having to use a cane to walk. What’s the difference?”
NSAIDs were specifically designed to help counteract the body’s inflammatory responses.
So what is a patient who has been taking them for osteoarthritis – whether by prescription or over-the-counter versions – to do?
Wilson said there’s no need to panic and the first step is to speak with a doctor.
“There are alternatives certainly that are not nonsteroidal anti-inflammatories that have to date not been shown to have some of the implications that NSAIDs do have for heart disease,” Wilson said. “We always encourage patients to to talk with their own physicians about what those alternatives could be.”