The impact of ethnicity and cardiovascular risk on the pharmacologic management of osteoarthritis: a US perspective

Abstract

Many individuals with osteoarthritis (OA) also have other chronic, comorbid conditions, such as obesity, hypertension and diabetes, which can compound the risk for developing cardiovascular adverse events that have been associated with specific analgesics, most notably nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitor NSAIDs. Pharmacotherapy may be further complicated by genetic factors that may influence drug metabolism in certain individuals. These risks may vary according to race and ethnicity. Black and Hispanic populations are known to have a higher prevalence of cardiovascular risk factors and disease, and a substantial proportion of black and Hispanic individuals possess genotypes of the cytochrome P450 (CYP) 2C9 enzyme involved in the metabolism of many NSAIDs and the CYP2D6 enzyme involved in metabolism of the dual opioid agonist/norepinephrine-serotonin reuptake inhibitor tramadol. As a result, the efficacy and safety of available analgesics may vary between patients in different racial and ethnic groups. This review article focuses on racial and ethnic differences in cardiovascular risk and genetic factors altering drug efficacy and safety and evaluates the pharmacologic options that can be used for the management of OA in these populations. Particular emphasis is given to the place of topical NSAIDs and capsaicin in the management of OA patients for whom systemic exposure to available pharmacotherapy poses particular risk. Evidence-based guidelines in OA management, as they relate to appropriate patient-specific pharmacotherapy, are also examined.

Keywords:

• African American
• black
• cardiovascular risk
• ethnicity
• Hispanic
• nonsteroidal anti-inflammatory drug
• osteoarthritis
• race

Acknowledgement

Technical, editorial, and medical writing assistance was provided by Dennis Stancavish, MA, Synchrony Medical, LLC, West Chester, PA and Robert Axford-Gatley, MD, C4 MedSolutions, LLC (Yardley, PA), a CHC Group company, with funding from Mallinckrodt Pharmaceuticals, Hazelwood, MO. Mallinckrodt made no contribution to the content of the manuscript; however, a courtesy copy of the finished manuscript was forwarded to the company at the time of submission.

Declaration of interest: The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. The author received no honorarium for writing this review. However, Mallinckrodt Pharmaceuticals, Hazelwood, MO, funded technical, editorial, and medical writing assistance provided by Synchrony Medical, LLC, West Chester, PA and C4 MedSolutions, LLC (Yardley, PA), a CHC Group company.