Non-steroidal anti-inflammatory drugs (NSAIDs) in rheumatoid arthritis: a potential risk factor for stroke or heart attack?

This study investigated if non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of heart attack or stroke in patients with rheumatoid arthritis (RA). They found that non-selective NSAIDs were associated with an increased risk of both stroke and heart attack in RA patients.

One type of medication used to treat RA are non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs block the activity of COX enzymes and reduce inflammation. Some NSAIDs are non-selective and target all COX enzymes; selective NSAIDs target a specific COX enzyme e.g. COX-2.

NSAIDs may also cause increases in blood pressure. This may increase the risk of stroke or heart attack. A stroke can be caused by a blockage (ischemic stroke), or a rupture (hemorrhagic stroke) in a blood vessel in the brain. It is unclear if patients taking NSAIDs to treat RA symptoms are at an increased risk of stroke or heart attack.

This study investigated if NSAIDs are associated with an increased risk of stroke and heart attack in patients with RA.

This study included almost 6,000 patients with RA that were hospitalized for a stroke (5001) or a heart attack (920). Information on patient characteristics, medical history and medication history from before the stroke or heart attack was gathered from a national medical database.

The use of NSAIDs over a 30-day period was associated with an increased risk of stroke (40%) and heart attack (73%). Non-selective NSAIDs over a 30-day period were associated with an increased risk of stroke only (39%). Higher doses of non-selective NSAIDs were associated with higher risk of stroke and heart attack. The non-selective NSAIDs diclofenac and mefenamic acid were associated with increased stroke and heart attack risk; ibuprofen was associated with stroke only. Other non-selective NSAIDs, celecoxib and meloxicam, were not associated with increased risk of stroke or heart attack.

The authors concluded that non-selective NSAIDs were associated with an increased risk of both stroke and heart attack in RA patients.

This study was conducted in a Taiwanese population. The results may not extend to other ethnicities. Information on important risk factors e.g. smoking, alcohol consumption and body mass index (BMI) were not available. These may also contribute significantly to stroke and heart attack risk.

If you have any concerns regarding NSAIDs and RA treatment, please consult with your doctor.