TY - JOUR
T1 - Cardiovascular safety of using non-steroidal anti-inflammatory drugs for gout
T2 - a Danish nationwide case-crossover study
AU - Bech-Drewes, Anne
AU - Bonnesen, Kasper
AU - Hauge, Ellen Magrethe
AU - Schmidt, Morten
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18 years of age with first-time gout during 1997–2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel–Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85–0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88–0.97) and naproxen (OR = 0.85, 95% CI: 0.74–0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90–1.05). Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients. Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac.
AB - Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18 years of age with first-time gout during 1997–2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel–Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85–0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88–0.97) and naproxen (OR = 0.85, 95% CI: 0.74–0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90–1.05). Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients. Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac.
KW - Cardiovascular disease
KW - Case-crossover study
KW - Gout
KW - Non-steroidal anti-inflammatory drugs
KW - Naproxen/adverse effects
KW - Humans
KW - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
KW - Middle Aged
KW - Cardiovascular Diseases/epidemiology
KW - Male
KW - Gout/drug therapy
KW - Diclofenac/adverse effects
KW - Cross-Over Studies
KW - Denmark/epidemiology
KW - Ibuprofen/adverse effects
KW - Female
KW - Adult
KW - Aged
UR - http://www.scopus.com/inward/record.url?scp=85189649463&partnerID=8YFLogxK
U2 - 10.1007/s00296-024-05584-7
DO - 10.1007/s00296-024-05584-7
M3 - Journal article
C2 - 38581450
AN - SCOPUS:85189649463
SN - 0172-8172
VL - 44
SP - 1061
EP - 1069
JO - Rheumatology International
JF - Rheumatology International
IS - 6
ER -