Journal of Pain Research (Mar 2024)
Identifying Risk Factors for Cardiovascular Events Among Active-Duty Service Members and Veterans Prescribed Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Abstract
Whitney L Forbes,1 Justin Petway,2 Laura E Gressler,3 Hannah Thorfinnson,4 Ryan C Costantino,1,5 Timothy J Atkinson2,6 1Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, Rosslyn, VA, USA; 2Department of Pharmacy, VA Tennessee Valley Healthcare System, Nashville, TN, USA; 3Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 4Department of Pharmacy, James A. Haley Veteran’s Hospital, Tampa, FL, USA; 5Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 6Pain Management, Opioid Safety, PDMP (PMOP) National Program Office, Department of Veterans Affairs, Washington, DC, USACorrespondence: Timothy J Atkinson; Laura E Gressler, Email [email protected]; [email protected]: Oral NSAIDs are widely used analgesic medications for the treatment of musculoskeletal and inflammatory conditions. NSAIDs are associated with adverse effects that arise from COX enzyme inhibition including cardiovascular events. The combined role of patient and prescription factors associated with NSAID use on cardiovascular risk is not well characterized.Objective: The purpose of this study is to identify the risk factors with cardiovascular events among NSAID users.Methods: This study is a retrospective, nested case–control study, within the DAVINCI database, among active-duty service members and veterans with at least one NSAID pharmacy claim between fiscal year (FY) 2015-FY2020. Inclusion criteria individuals ≥ 18 years of age received a prescription NSAID for ≥ 7-day supply and a duration ≥ 1 month overall. Cases experienced nonfatal myocardial infarction, nonfatal stroke, or new onset heart failure. Ten controls were selected per case. Risk factors were identified through logistic regression modeling.Results: The risk factors with strongest association to the primary outcome included age starting at 45 up to 75 and older, the first 90 days of NSAID exposure, cerebrovascular disease, cardiomyopathy, and history of myocardial infarction. Cox-selectivity and dose did not appear to be clinically significant in their association with cardiovascular events.Conclusion: The results of this study indicate that age, initial NSAID exposure, and comorbidities are more predictive than NSAID-specific factors such as COX-selectivity and dose. The results provide the framework for development of a risk score to improve prediction of NSAID-associated cardiovascular events.Keywords: NSAID, cardiovascular, myocardial infarction, stroke, heart failure
