title: 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.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center , Rotterdam , The Netherlands.
authors.forename: Aafke R
authors.initials: AR
authors.lastname: Koffeman
authors.forename: Vera E
authors.initials: VE
authors.lastname: Valkhoff
authors.forename: Geert W'T
authors.initials: GW
authors.lastname: Jong
authors.forename: Margreet F
authors.initials: MF
authors.lastname: Warlé-van Herwaarden
authors.forename: Patrick J E
authors.initials: PJ
authors.lastname: Bindels
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: Pim A J
authors.initials: PA
authors.lastname: Luijsterburg
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D000075202:Contraindications; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000188:drug therapy* / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D017891:Pharmacoepidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D056737:Safety-Based Drug Withdrawals; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors
keywords: Cardiovascular diseases; The Netherlands; general practice; musculoskeletal diseases; non-steroidal anti-inflammatory agents; pharmacoepidemiology