While the use of prescription nonsteroidal anti-inflammatory drugs (NDSAIDs) in patients with cardiovascular disease (CVD) declined between 1988 and 2016, there is still a subset of high-risk CVD patients that continue to use these agents, according to the findings of a recent study published in the Journal of the American College of Clinical Pharmacy.

As little is known about the long-term use of prescription NSAIDs within the CVD population in a real-world setting, this study aimed to analyze the trends of use in US adults with CVD between 1988 and 2016. Cross-sectional data from the National Health and Nutrition Examination Survey from 1988 to 1994 and 1999 to 2016 were obtained in order to identify patients 18 years of age and older with hypertension (defined by self-report, average blood pressure ≥140/90 mmHg, or use of antihypertensive medication) or 20 years of age and older with self-reported congestive heart failure (CHF), coronary heart disease (CHD), angina, myocardial infarction (MI), or stroke. The study authors analyzed the prevalence of prescription NSAID use in 6-year examination periods and performed weighted logistic regression in order to assess trends in prescription NSAID use over time.

Findings of the study revealed that use of prescription NSAIDs declined among all CVD populations overall. The study authors reported that the prevalence of overall prescription NSAID use was highest during the 1999-2004 examination years, and then declined during the 2005-2010 and 2011-2016 examination years. The prevalence of NSAID use decreased from 13.9% (1999-2004) to 8.5% (2011-2016) for patients with hypertension, 14.6% to 8.5% for patients with CHF, 16.3% to 7.4% for patients with CHD, 17.6% to 8.5% for patients with angina, 16.1% to 9.0% for patients with MI, and 15.7% to 7.9% for patients with stroke.

Findings also revealed that use of non-selective NSAIDs remained relatively stable during the same period, unlike COX-2-selective inhibitors, where a decrease of use was observed. “Trends in prescription NSAID use were reflective of the general adult population,” the authors also added.


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According to the findings of this study, use of prescription NSAIDs declined between 1988 and 2016 among patients with CVD, especially when comparing the 1999-2004 and the 2005-2010 examination periods. “This sharp decline was driven by a reduction in COX-2-selective inhibitor use during this time period, coinciding with the withdrawal of two COX-2-selective inhibitors, rofecoxib and valdecoxib, from the US market, and well-publicized concerns regarding potential increased risk of adverse cardiovascular events with COX-2-selective inhibitors, more generally,” the authors stated.

Despite this, prescription NSAIDs were continually used in a subset of these CVD populations, particularly in patients with hypertension. “Our results suggest that increased efforts may be necessary to minimize the use of prescription NSAIDs, and encourage alternative options where feasible, among patients with CVD,” the authors concluded.

Reference

1.      Hwang AY, Smith SM. U.S. Trends in Prescription Nonsteroidal Anti-inflammatory Drug Use Among Patients with Cardiovascular Disease, 1988–2016. [published online November 24, 2020]. J Am Coll Clin Pharm. 2020. doi: 10.1002/PHAR.2488.