Higher doses of NSAID carry increased CVD risk in ankylosing spondylitis patients

Patients with ankylosing spondylitis who are exposed to higher doses of nonsteroidal anti-inflammatory drugs (NSAIDs) appear to have an elevated risk of cardiovascular disease (CVD), according to a study.

Researchers used data from the Korean National Health Insurance database and identified patients with a new diagnosis of ankylosing spondylitis who had no prior CVD. The primary endpoint was CVD, defined as a composite of ischaemic heart disease, stroke, or congestive heart failure.

A time-varying approach was used to evaluate exposure to NSAIDs, with the dose considered in each exposure period. Cox proportional hazard regression models were applied to explore the relationship between the incidence of CVD and exposure to NSAIDs.

A total of 19,775 patients (mean age 36 years, 75 percent male) were included in the analysis. Of these, 19,706 received NSAID treatment. There were 1,663 cases of CVD documented—including 1,157 cases of ischaemic heart disease, 301 cases of stroke, and 613 cases of congestive heart failure—over 98,290 person-years of follow-up.

Increasing the dose of NSAIDs was positively associated with the risk of incident CVD (adjusted HR [aHR], 1.10, 95 percent confidence interval [CI], 1.08–1.13), including ischaemic heart disease (aHR, 1.08, 95 percent CI, 1.05–1.11), stroke (aHR, 1.09, 95 percent CI, 1.04–1.15), and congestive heart failure (aHR, 1.12, 95 percent CI, 1.08–1.16).

The association was consistently observed in different subgroups.