{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:54:46Z","timestamp":1784883286406,"version":"3.55.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Topical\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              s have less systemic absorption than oral\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              s. We examined the risk of cardiovascular events associated with nonselective topical NSAIDs versus oral NSAIDs among patients with rheumatoid arthritis in Taiwan.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a retrospective cohort study that included patients with incident rheumatoid arthritis who were newly starting therapy with nonselective topical NSAIDs or oral NSAIDs. We used the Taiwan National Health Insurance Research Database (\n              <jats:styled-content style=\"fixed-case\">NHIRD<\/jats:styled-content>\n              ). The first date patients received either type of\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              was defined as the index date.\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              exposures continued until there was a treatment gap of &gt;30\u00a0days. The main outcome was composite cardiovascular events, including myocardial infarction, unstable angina, heart failure, stroke, or revascularization. Follow\u2010up was censored at treatment discontinuation, switch or addition of other\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              category, cardiovascular outcome, death, or the end of the study. Propensity score weighted Cox regression models were used to compare the risk of cardiovascular events between topical NSAIDs and oral NSAIDs. There were 10\u00a0758 and 78\u00a0056 treatment episodes for topical and oral\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              s identified. After weighting by propensity score, the cohorts were well balanced over all covariates. The crude cardiovascular event rate was 1.87 per 100\u00a0person\u2010years for topical\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              s and 2.14 per 100 person\u2010years for oral\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              s. Results of propensity score weighted Cox regression found the topical NSAID group had 36% lower risk for cardiovascular events compared with the oral NSAID group (hazard ratio, 0.64; 95% confidence interval, 0.43\u20130.95).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We found topical NSAID users experienced a reduced risk of cardiovascular events compared with oral NSAID users. If future studies with a larger sample size and longer follow\u2010up confirm these results,\n              <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>\n              prescribing might change accordingly.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.006874","type":"journal-article","created":{"date-parts":[[2017,10,28]],"date-time":"2017-10-28T00:10:32Z","timestamp":1509149432000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Comparative Risk of Cardiovascular Outcomes Between Topical and Oral Nonselective NSAIDs in Taiwanese Patients With Rheumatoid Arthritis"],"prefix":"10.1161","volume":"6","author":[{"given":"Tzu\u2010Chieh","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"},{"name":"Division of Pharmacoepideimiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA"},{"name":"Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yea\u2010Huei","family":"Kao Yang","sequence":"additional","affiliation":[{"name":"Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan"},{"name":"School of Pharmacy, College of Medicine, Tainan, Taiwan"},{"name":"Institute of Clinical Pharmacy and Pharmaceutical Science, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2005.050377"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000054612.26458.B2"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60900-9"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c7086"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2011.45"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0554-0"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.391"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.076760"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270009336234"},{"key":"e_1_3_3_11_2","first-page":"CD007402","article-title":"Topical NSAIDs for acute musculoskeletal pain in adults","volume":"6","author":"Derry S","year":"2015","unstructured":"Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. 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