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