Ischaemic cardiovascular risk and prescription of non-steroidal anti-inflammatory drugs for musculoskeletal complaints

Abstract

Objective. To determine the influence of ischaemic cardiovascular (CV) risk on prescription of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners (GPs) in patients with musculoskeletal complaints. Design. Cohort study. Setting. A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands. Patients. A total of 474 201 adults consulting their GP with a new musculoskeletal complaint between 2000 and 2010. Patients were considered at high CV risk if they had a history of myocardial infarction, angina pectoris, stroke, transient ischaemic attack, or peripheral arterial disease, and at low CV risk if they had no CV risk factors. Main outcome measures. Frequency of prescription of non-selective (ns)NSAIDs and selective cyclooxygenase-2 inhibitors (coxibs). Results. Overall, 24.4% of patients were prescribed an nsNSAID and 1.4% a coxib. Of the 41,483 patients with a high CV risk, 19.9% received an nsNSAID and 2.2% a coxib. These patients were more likely to be prescribed a coxib than patients with a low CV risk (OR 1.9, 95% CI 1.8–2.0). Prescription of nsNSAIDs decreased over time in all risk groups and was lower in patients with a high CV risk than in patients with a low CV risk (OR 0.8, 95% CI 0.7–0.8). Conclusion. Overall, patients with a high CV risk were less likely to be prescribed an NSAID for musculoskeletal complaints than patients with a low CV risk. Nevertheless, one in five high CV risk patients received an NSAID, indicating that there is still room for improvement.

Time‐trends in the prescribing of gastroprotective agents to primary care patients initiating low‐dose aspirin or non‐steroidal anti‐inflammatory drugs: a population‐based cohort study

“…In the NSAID cohort, a decrease in coxib prescription was observed in 2005. This decrease has also been found in previous studies and appears to be in response to the removal of rofecoxib from the market in 2004, after evidence emerged that its use was associated with an increased incidence of ischaemic cardiovascular events . Other environmental factors, such as the availability of cheaper generic PPIs since 2002, do not appear to have played a strong role in prescribing behaviour.…”

“…Low-dose aspirin (LDA) and non-steroidal anti-inflammatory drugs (NSAIDs) are both widely used in primary care [1,2]. They are associated with an increased risk of serious upper gastrointestinal events (UGIEs), such as ulceration, bleeding and perforation [3][4][5][6][7].…”

NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

“…10 Further, our findings were relatively consistent with studies from Europe and North America, but we note that only one 12 of these studies was conducted the RACF setting and most did not use medication administration data. [10][11][12][16][17][18][19] Higher use of any NSAIDs in our sample compared with prior studies may be attributable to differences in participant characteristics (eg, our sample of older sicker people living in residential aged care may have more need for pain treatment), methods of measurement of medication use (ie, studies using self-report or claims data are subject to measurement error), and potential differences in prescribing practices.…”

“…Use of NSAIDs increased during 2002 to 2007 across several central and eastern European countries . In The Netherlands, during 2000 to 2010, general practice patients with cardiovascular risk factors were less likely to receive NSAIDs for musculoskeletal complaints, but the prevalence of NSAID use among these high‐risk patients was still 20% . Among people aged greater than or equal to 60 in 2006 in Norway, 7% had a prescription for an NSAID, and many also had a prescription for hypertension or heart failure medications .…”

“…18 In The Netherlands, during 2000 to 2010, general practice patients with cardiovascular risk factors were less likely to receive NSAIDs for musculoskeletal complaints, but the prevalence of NSAID use among these high-risk patients was still 20%. 19 Among people aged greater than or equal to 60 in 2006 in Norway, 7% had a prescription for an NSAID, and many also had a prescription for hypertension or heart failure medications. 20 Many prior studies have used prescribing data, claims data, or self-reported medication use, which underestimate true NSAID use, and most of the studies were conducted in settings other than RACFs.…”