Risk of myocardial infarction with use of selected nonsteroidal anti-inflammatory drugs in spondyloarthritis patients
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BACKGROUND: Spondyloarthritis (SpA) is associated with increased risk of myocardial infarction (MI); the risk may be due to the underlying inflammatory disease, or also due to medications that increase MI risk, such as certain non-steroidal anti-inflammatory drugs (NSAIDs). OBJECTIVES: 1. To describe the risk of myocardial infarction (MI) among patients with spondyloarthritis who are prescribed NSAIDs 2. To compare the pattern of MI risk with specific NSAID use among spondyloarthritis patients with the pattern of risk among patients with osteoarthritis (OA) METHODS: Nested case-control studies were performed using 1994–2015 data from The Health Improvement Network (THIN). Underlying cohorts included adult patients with incident SpA or OA had >1 NSAID prescriptions and no history of MI. In each cohort, we matched cases of incident MI to four controls without MI. NSAID use was categorized as: (A) current (prescription end date 0–180 days prior to index date), (B) recent (181–365 days), or (C) remote (>365 days). We performed conditional logistic regression to compare the odds of current or recent NSAID use relative to remote use of any NSAID, considering diclofenac and naproxen specifically. RESULTS: Within the SpA cohort of 8140 and the OA cohort of 244,399, there were 115 and 6287 MI cases, respectively. After adjustment, among SpA subjects, current diclofenac use was associated with an OR of 3.05 (95% CI 1.48–6.29; Table 2) for MI. Naproxen use was not associated with any increase (adjusted OR 1.25, 95% CI 0.56–2.78). A ratio of ORs for SpA/diclofenac relative to OA/diclofenac was 2.35 (1.10–4.90).
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