Cause for concern in the use of non-steroidal anti-inflammatory medications in the community -A population-based study

The Health Observatory, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville Road, Woodville, SA, Australia.
BMC Family Practice (Impact Factor: 1.67). 07/2011; 12(1):70. DOI: 10.1186/1471-2296-12-70
Source: PubMed


Non-steroidal anti-inflammatory (NSAID) medications are a common cause of reported adverse drug side-effects. This study describes the prevalence of non-steroidal anti-inflammatory (NSAID) use (other than low-dose aspirin) and the presence of co-existing relative contraindications to NSAID use and chronic conditions in a representative population sample.
Data were analysed from 3,206 adults attending first follow-up of the North West Adelaide Health Study (NWAHS) in 2004-2006, a longitudinal representative population study. Medications were brought into study clinic visits by participants. Clinical assessment included measured blood pressure, kidney function, serum cholesterol, blood glucose. Questionnaires assessed demographics, lifestyle risk factors, physician-diagnosed chronic conditions. Data were weighted to census measures by region, age group, gender, and probability of selection in the household, to provide population representative estimates. Pearson's Chi-square tests determined significant differences in proportions. Multiple logistic regression was used to examine associations of socio-demographic characteristics with use of NSAIDs.
Of 3,175 participants, 357 (11.2%), and 16% of those aged > 55 years, reported using either non-specific NSAIDs or COX-2 inhibitors, other than low-dose aspirin. Among people using NSAIDs, 60.8% had hypertension, 30.8% had Stage 3 or higher chronic kidney disease, 17.2% had a history of cardiovascular disease (CVD) and 20.7% had a > 15% 10-year CVD risk. The prevalence of NSAID use among people with hypertension was 16%, with kidney disease 15.9%, and a history of CVD 20.0%. Among people taking diuretics, 24.1% were also taking NSAIDs, and of those taking medications for gastro-esophageal reflux, 24.7% were on NSAIDs. Prescription-only COX-2 inhibitors, but not other NSAIDs, were used more by people > 75 years than by 35-54 year olds (OR 3.7, 95% CI 2.0, 6.7), and also were more commonly used by people with hypertension, cardiac and kidney disease.
There is a high prevalence of current NSAID use among groups at-risk for significant drug-related adverse events or who have major chronic conditions that are relative contraindications to NSAID use. Assessment of absolute risks regarding cardiovascular and kidney disease need to take into account use of medications such as NSAIDs. The potential to make a substantial impact on chronic disease burden via improved use of NSAIDs is considerable.

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Available from: Catherine Hill
    • "This is in contrast to a study that found a high prevalence of NSAID use in people with cardiovascular disease, hypertension, and chronic kidney disease [2]. Previous studies of community-dwelling older people reported NSAID use of 12% to 19% among people aged 75 years and over [2] [24] [37]. A recent study indicates that the trends in prevalence use of NSAIDs are increasing. "
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    ABSTRACT: The evidence on the patterns of non-steroidal anti-inflammatory drugs (NSAIDs) use according to pain prevalence and clinical guidelines in older people is sparse. This cross-sectional study examined the patterns of NSAIDs use according to pain prevalence and concordance with specific clinical guideline recommendations for safe NSAIDs use in older people, in relation to duration of use, patterns of use, concomitant use of proton pump inhibitors (PPIs), and prevalence of specific drug interactions. Community-dwelling men (n=1696) aged ⩾70 years living in Sydney were studied. 8.2% (n=139) of participants reported regular NSAIDs use compared with 2.9% (n=50) reporting as needed use. The mean treatment duration for regular NSAIDs use was 4.9 years suggesting long-term rather than short-term use as recommended by the guidelines. While guidelines recommend use of PPIs together with an NSAID, only 25.2% of regular NSAIDs users reported PPIs use. Regular NSAIDs users were significantly more likely to report use of opioid analgesics (p<0.0001) compared with non-regular users. In relation to pain prevalence, regular NSAIDs users were significantly more likely to report chronic pain (p<0.0001), recent pain (p=0.0001) and chronic intrusive pain (p<0.0001) compared with non-regular users. The findings of this study indicate that NSAIDs prescribing practices do not align with specific clinical practice guidelines for safe use in older people. This difference between the guideline recommendation and what is happening in the "real world" should be explored further.
    No preview · Article · Jun 2014 · Pain
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    • "Every hypertensive patient was treated with antihypertensive medication. Our results are in line with the results of Adams et al. (2011) who found that 60.8% of NSAID users have arterial hypertension and with the results of Lanas (2011) who documented antihypertensive pharmacotherapy in 57.6% of NSAID users. The most widely used antihypertensive drugs in our study group were drugs with high risk of decrease in antihypertensive effect when co-administered with NSAIDs (Johnson et al., 1994). "
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    ABSTRACT: Non-steroidal anti-inflammatory drugs (NSAIDs) belong to the most widely prescribed and used pharmacological agents worldwide. Data gathered in the last decade show increased incidence of thrombotic events during NSAID administration. Analysis of NSAID usage and assessment of risk for development of cardiovascular adverse effects is needed for improving patient safety. For limiting the impact of adverse effects on the health of patients, NSAID users should be informed about the possible adverse effects and their symptoms to ensure early detection and treatment discontinuation. In the presented study, we retrospectively analyzed the administration of NSAIDs in a group of patients (n=428) in need of analgesic treatment hospitalized at a department of internal medicine. Factors increasing the risk for cardiovascular adverse effects were also investigated. A separate questionnaire study was conducted to gather information concerning the knowledge of hospitalized NSAID users (n=251) about adverse effects of the medication used. For purpose of comparison, we conducted a similar study in a group of 234 random respondents from a shopping center. Data were evaluated using descriptive statistics, Student's t-test and chi-squared test. Our results suggest that the majority of patients treated with NSAIDs have factors indicating increased risk of development of adverse effects, most commonly arterial hypertension (58.2% of patients). The results of our questionnaire study show limited knowledge of NSAID users about the risk of the therapy. Nearly half of the respondents were unaware of any adverse effects. We consider as alarming that only a limited number of respondents were informed by their physician or pharmacist about the possible risks of treatment. In conclusion, we found that hospitalized NSAID users often have a history of diseases predisposing to the development of cardiovascular adverse effects of NSAIDs. Despite this, their knowledge about the risk of treatment is insufficient.
    Full-text · Article · Sep 2013 · Interdisciplinary toxicology
    • "Several randomized studies3435 have demonstrated that various NSAID elevate the blood pressure in elderly and hypertensive individuals. TKA, gives relief from pain and hence NSAID intake would be stopped postoperatively. "
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    ABSTRACT: Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure. A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired 't' test. The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3. Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.
    No preview · Article · Mar 2013 · Indian Journal of Orthopaedics
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