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Editor's Correspondence
November 26, 2007

Arthritis Is Associated With Cardiovascular Disease in the Users of Analgesics and Nonsteroidal Anti-inflammatory Drugs

Arch Intern Med. 2007;167(21):2371-2372. doi:10.1001/archinte.167.21.2371-b

In the article by Forman et al1 titled “Frequency of Analgesic Use and Risk of Hypertension Among Men,” the authors conclude that the frequency of nonnarcotic analgesic use is independently associated with a moderate increase in the risk of incident hypertension. This conclusion is questionable because of an important omission. The authors have not considered, as a covariate, the underlying reason for the use of analgesics and anti-inflammatory drugs. It is well established that inflammatory diseases such as arthritis, which the examined drugs are used for, adversely affect the cardiovascular system so that patients with arthritis are afflicted with cardiovascular conditions to a significantly greater extent than the general population.24 This is associated with a rise in proinflammatory mediators. The presented data do not differentiate between the disease, its severity and progression, and the drugs. It is not surprising, therefore, that the patients who take the drugs every day (and hence, may be afflicted with more severe inflammatory diseases) have significantly higher risk ratios than those who do not take any analgesics and are presumably healthy. The authors, therefore, cannot conclude that the drugs alone were the cause of the increased risk of hypertension.

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