Analgesic use and risk of acute coronary events in patients with osteoarthritis: a population-based nested case-control study

Purpose: Recent controversies on the safety profile of opioids and paracetamol have led to changes in clinical guidance for osteoarthritis (OA) management. We studied the existing association between the use of different OA drug therapies and the risk of acute coronary events (ACE). Methods: A cohort of patients with clinically diagnosed OA (according to ICD10 codes) was identified in the SIDIAP database. Within the cohort, cases with incident ACE (AIM or unstable angina) between 2008 and 2012 were identified using ICD10 codes and data from hospital admission. Controls were 3 ACE-free subjects matched by sex, age (±5 years), area, and year of OA diagnosis (±2 years). Linked pharmacy dispensation data was used to assess exposure to drug therapies. Multivariable conditional logistic regression models were fitted to estimate adjusted odds ratio (OR) for ACE. Findings: 5663 cases and 16989 controls were studied. Previous morbidity and cardiovascular risk was higher in cases than controls, with no differences in type or number of joints with OA. Multivariable adjusted analyses showed increased risks (OR(95%CI)) related to the use of diclofenac (1.16 (1.06 - 1.27)), naproxen (1.25 (1.04 - 1.48)) and opioid analgesics (1.13 (1.03 - 1.24). No significant associations were observed for COX-2 selective NSAIDs, topical NSAIDs, glucosamine, chondroitin sulphate, paracetamol or metamizole. Implications: In patients with clinically diagnosed OA, the use of non-selective NSAIDs or opioid analgesics is associated with an increased risk of acute coronary events. These risks should be considered when selecting treatments for OA in patients with high cardiovascular risk