<--GAT-->

VA Study: CV Risks Lower in Patients Taking NSAID, Misoprostol Combo

by U.S. Medicine

June 14, 2017

By Brenda L. Mooney

Mark Munger, PharmD, professor of pharmacotherapy at the University of Utah College of Pharmacy

SALT LAKE CITY — Use of nonsteroidal anti-inflammatory (NSAID) drugs has been linked to a higher risk of cardiovascular issues, but a new study offers a possible way to mitigate that factor.

A recent conference presentation suggested that patients who took misoprostol, used to prevent stomach ulcers, along with NSAIDs significantly lowered their risks of such events, as well as stroke and kidney failure, compared to those who took NSAIDS alone.

The research was presented at the American College of Cardiology’s 66th Annual Scientific Session in Washington this spring.1

The study team from the Salt Lake City VAMC and the University of Utah noted that NSAIDS are the most commonly used prescription and over-the-counter analgesic medications worldwide, but their use is limited by an increase in cardio-renal morbidity and mortality risk.

“Withdrawal of the balancing vasodilatory prostaglandins on vascular, thrombotic and renal physiological mechanisms by NSAIDs contributes to the cardio-cerebro-renal vascular event risk,” they pointed out, adding, “We hypothesized that restoration of prostanoids through the concomitant use of misoprostol with NSAIDs may reduce the adverse event risk.”

“Right now, clinicians have no direct treatment options to reduce the risk for these NSAID-induced cardio-renal complications, other than to advise against NSAID use, reduce the duration of use or recommend alternative pain management agents, so we set out to discover a treatment to reduce the risk of these effects,” explained lead author Mark Munger, PharmD, FCCP, professor of pharmacotherapy at the University of Utah College of Pharmacy. “Our data, from a large and well-characterized healthcare system, support a potentially safer NSAID alternative when NSAIDs are combined with misoprostol.”

The researchers conducted a historical cohort study using the VA database to compare new initiators of 11 different NSAIDs and/or misoprostol from 2005 through 2013, for a total of nearly 1.7 million subjects. The veterans were followed for five years, with a focus on development of cardiovascular, cerebrovascular or renal-vascular events. 

Patients taking NSAIDs and misoprostol together lowered by 44% their risk of having a heart attack, suffering cardiac arrest or having ventricular fibrillation, according to the study. At the same time, those taking both drugs also had a 25% lower risk of strokes or mini-strokes and a 34% lower risk of acute kidney failure compared to people taking NSAIDs alone.

The study involved two treatment groups, each containing 1,827 patients. Results indicate that NSAID plus misoprostol significantly reduced cardiovascular [hazard ratio (HR) of 0.56], cerebrovascular (HR of 0.75) and reno-vascular (0.66) vs. NSAID alone. All-cause mortality was not statistically different between groups, however, with an HR of 1.05.

“Taking misoprostol in conjunction with a NSAID significantly reduced the risk of NSAID-induced cardiovascular, cerebrovascular, and reno-vascular adverse events associated with taking NSAIDS alone,” study authors conclude. “This data from a large and well characterized healthcare system database supports a safer analgesic, an NSAID combined with misoprostol.”

“Hopefully we can reduce the incidence of NSAID-induced cardio-renal adverse effects, which could be especially important in an era in which pain management is in flux,” Munger added, pointing out that the growing problem of opioid abuse and addiction have made it even more critical to improve the safety profile of NSAIDs. 

  1. Munger M, Nelson SD, Teng CC, Bress A, Sauer B., Reduced Risk of NSAID Induced Adverse Events With Concomitant Use of Misoprostol, presented at ACC 17, 66TH Annual Scientific Session & Expo in Washington. March 17-19, 2017.

Related Articles

Demand surges for popular army clinical pharmacy course

With pharmacists from across the DoD and VA clamoring for spots in the Clinical Pharmacy Course at Army Medical Department Center and School (AMEDDCS) in Fort Sam Houston, TX, organizers offered back-to-back programs this spring, with another scheduled for August.

VA faces healthcare staffing shortages, barriers to hiring facility leaders

A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.


U.S. Medicine Recommends


More From department of veterans affairs

Department of Veterans Affairs (VA)

VA faces healthcare staffing shortages, barriers to hiring facility leaders

A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.

Department of Veterans Affairs (VA)

Veteran nephrologist labors to improve ESRD treatment at VA

When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.

Department of Veterans Affairs (VA)

Committee approves bill to provide agent orange benefits to ‘blue water’ vets

A long sought-after bill that would make it easier for Blue Water Navy veterans to receive Agent Orange benefits has been passed by a key House of Representatives committee.

Department of Veterans Affairs (VA)

Bill to Streamline, Expand VA’s Choice Program Signed Into Law

Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..

Department of Veterans Affairs (VA)

Despite Criticism, VA Healthcare as Good or Better Than Other Systems

The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up