Association of Tramadol with Risk of Myocardial Infarction Among Patients with Osteoarthritis

Details

• Alternative Title:
  Osteoarthritis Cartilage
• Personal Author:
  Wei, Jie ; Wood, Malissa J ; Dubreuil, Maureen ; Tomasson, Gunnar ; LaRochelle, Marc R. ; Zeng, Chao ; Lu, Na ; Lin, Jianhao ; Choi, Hyon K. ; Lei, Guanghua ; Zhang, Yuqing
• Description:
  Objective
  
  Tramadol has been widely used among patients with osteoarthritis (OA); however, there is paucity of information on its cardiovascular risk. We aimed to examine the association of tramadol with risk of myocardial infarction (MI) among patients with OA.
  
  Design
  
  Among OA patients aged 50 to 90 years without history of MI, cancer, or opioid use disorder in The Health Improvement Network database in the United Kingdom (2000-2016), three sequential propensity-score matched cohort studies were assembled, i.e., (1) patients who initiated tramadol or naproxen (negative comparator); (2) patients who initiated tramadol or diclofenac (positive comparator); and (3) patients who initiated tramadol or codeine (a commonly used weak opioid). The outcome was incident MI over six-months.
  
  Results
  
  Among tramadol and naproxen initiators (n=33,024 in each cohort), 77 (4.8/1000 person-years) and 46 (2.8/1000 person-years) incident MI occurred, respectively. The rate difference (RD) and hazard ratios (HR) for incident MI with tramadol initiation were 1.9 (95% confidence interval [CI] 0.6 to 2.3)/1000 person-years and 1.68 (95% CI 1.16 to 2.41) relative to naproxen initiation, respectively. Among tramadol and diclofenac initiators (n=18,662 in each cohort), 58 (6.4/1000 person-years) and 47 (5.1/1000 person-years) incident MIs occurred, respectively. The corresponding RD and HR for incident MI were 1.2 (95%CI −2.1 to 14.1)/1000 person-years and 1.24 (95%CI 0.84 to 1.82), respectively. Among tramadol and codeine initiators (n=42,722 in each cohort), 127 (6.1/1000 person-years) and 103 (5.0/1000 person-years) incident MI occurred, respectively, and the corresponding RD and HR were 1.1 (95%CI:−0.3 to 2.5)/1000 person-years and 1.23 (95%CI:0.95 to 1.60), respectively.
  
  Conclusions
  
  In this population-based cohort of patients with OA, the six-month risk of MI among initiators of tramadol was higher than that of naproxen, but comparable to, if not lower than, those of diclofenac or codeine.
  
  
• Subjects:
  Article Cohort Myocardial Infarction Osteoarthritis Tramadol
• Source:
  Osteoarthritis Cartilage. 28(2):137-145
• Pubmed ID:
  31629022
• Pubmed Central ID:
  PMC7047659
• Document Type:
  Journal Article
• Funding:
  K23 AR069127/AR/NIAMS NIH HHS/United States ; K23 DA042168/DA/NIDA NIH HHS/United States ; P60 AR047785/AR/NIAMS NIH HHS/United States
• Volume:
  28
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e0fc4c8acdd7283233ad3033ce2a2e8c596a33167c64340577bc6621dcdbe4a2
• Download URL:
  https://stacks.cdc.gov/view/cdc/101066/cdc_101066_DS1.pdf
• File Type:
  [PDF - 527.35 KB ]