The University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Rheumatol. 2019 Nov;71(11):1835-1843. doi: 10.1002/art.41027. Epub 2019 Sep 5.
To elucidate the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the increased risk of cardiovascular disease (CVD) among osteoarthritis (OA) patients.
This longitudinal study was based on linked health administrative data from British Columbia, Canada. From a population-based cohort of 720,055 British Columbians, we selected 7,743 OA patients and 23,229 age- and sex-matched non-OA controls. We used multivariable Cox proportional hazards models to estimate the risk of developing incident CVD (primary outcome) as well as ischemic heart disease, congestive heart failure, and stroke (secondary outcomes). To estimate the mediating effect of NSAIDs, defined as current use of an NSAID according to linked PharmaNet data, in the OA-CVD relationship, we implemented a marginal structural model.
OA patients had a higher risk of developing CVD than controls without OA. After adjusting for socioeconomic status, body mass index, hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, and Romano comorbidity score, the adjusted hazard ratio (HR) was 1.23 (95% confidence interval [95% CI] 1.17-1.28). The adjusted HRs for congestive heart failure, ischemic heart disease, and stroke were 1.42 (95% CI 1.33-1.51), 1.17 (95% CI 1.10-1.26), and 1.14 (95% CI 1.07-1.22), respectively. Approximately 41% of the total effect of OA on increased CVD risk was mediated through NSAIDs. For the secondary outcomes, the proportion mediated through NSAIDs was 23%, 56%, and 64% for congestive heart failure, ischemic heart disease, and stroke, respectively.
The findings of this first study to evaluate the mediating role of NSAIDs in the relationship between OA and CVD suggest that NSAID use contributes substantially to the OA-CVD association.
阐明非甾体抗炎药（NSAIDs）在骨关节炎（OA）患者心血管疾病（CVD）风险增加中的作用。
本纵向研究基于加拿大不列颠哥伦比亚省的健康管理数据。从一个基于人群的不列颠哥伦比亚省 720055 名居民中，我们选择了 7743 名 OA 患者和 23229 名年龄和性别匹配的非 OA 对照。我们使用多变量 Cox 比例风险模型来估计发生 CVD（主要结局）以及缺血性心脏病、充血性心力衰竭和中风（次要结局）的风险。为了估计 NSAIDs（根据 PharmaNet 数据确定的当前 NSAIDs 使用情况）在 OA-CVD 关系中的中介作用，我们实施了边缘结构模型。
OA 患者发生 CVD 的风险高于无 OA 的对照组。在校正社会经济地位、体重指数、高血压、糖尿病、高脂血症、慢性阻塞性肺疾病和 Romano 合并症评分后，调整后的危险比（HR）为 1.23（95%置信区间 [95%CI] 1.17-1.28）。充血性心力衰竭、缺血性心脏病和中风的调整 HR 分别为 1.42（95%CI 1.33-1.51）、1.17（95%CI 1.10-1.26）和 1.14（95%CI 1.07-1.22）。OA 对 CVD 风险增加的总影响约有 41%是通过 NSAIDs 介导的。对于次要结局，通过 NSAIDs 介导的比例分别为充血性心力衰竭、缺血性心脏病和中风的 23%、56%和 64%。
这是第一项评估 NSAIDs 在 OA 和 CVD 之间关系中介作用的研究，结果表明 NSAIDs 的使用对 OA-CVD 关联有很大贡献。
