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
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• 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
  • Osteoarthritis
  • Tramadol
  • Myocardial Infarction
  • Cohort
• 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
• Download URL:
  https://stacks.cdc.gov/view/cdc/101066/cdc_101066_DS1.pdf
• File Type:
  [PDF - 527.35 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e0fc4c8acdd7283233ad3033ce2a2e8c596a33167c64340577bc6621dcdbe4a2