Background/Purpose: Ankylosing spondylitis (AS) is associated with increased cardiovascular disease, but there are limited data as to whether prolonged treatment with non-steroidal anti-inflammatory drugs (NSAIDs) increases the cardiovascular risk in AS patients. We aimed to examine the risk of cardiovascular disease associated with long-term use of NSAIDs in a large real-world AS cohort.

Methods: A nationwide population-based cohort of patients with AS and matched controls without AS were analysed. The primary outcome was cardiovascular disease, a composite outcome of ischemic heart disease, stroke, or congestive heart failure. Long-term use of NSAIDs was defined as use of NSAIDs for more than 365 cumulative defined daily doses. The association between long-term use of NSAIDs and incident cardiovascular disease was examined using a multivariable Cox proportional hazards regression model in both AS and non-AS populations.

Results: Among 19,775 patients with AS and 59,325 matched controls without AS, there were 1,663 and 4,308 incident cases of cardiovascular disease, showing an incidence of 16.9 and 13.8 per 1,000 person-years, respectively. Long-term use of NSAIDs increased the risk of cardiovascular disease in non-AS controls (adjusted hazard ratio [aHR], 1.64; 95% CI, 1.48–1.82). In contrast, long-term use of NSAIDs did not increase the risk of cardiovascular disease in AS patients (aHR, 1.06; 95% CI, 0.94–1.20; adjusted for age, sex, socioeconomic status, body mass index, smoking status, hypertension, diabetes, hyperlipidemia, and tumor necrosis factor inhibitor use).

Conclusion: Prolonged NSAID treatment in AS patients may not be as harmful as in the general population regarding cardiovascular risk.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-cardiovascular-disease-associated-with-long-term-use-of-nsaids-in-ankylosing-spondylitis/