Could NSAIDs Raise the Risk of Heart Failure?

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed, 9 of them have been identified as increasing the risk of hospitalization due to heart failure, according to a new study.

To better understand the link between NSAIDs and heart failure risk, the researchers searched 5 population-based databases from the Netherlands, Italy, Germany, and the United Kingdom for hospital admissions for heart failure.
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They found 93,163 results and compared those cases with 8,246,403 controls matched by age, sex, and year of cohort study.

Then the researchers assessed the risk of hospitalization due to heart failure and the use of 27 different NSAIDs.

Results showed that patients who had taken an NSAID within the previous 14 days of baseline had a 19% increased risk of hospitalization due to heart failure than those who took an NSAID within 6 months.

Of the 23 traditional NSAIDs and the 4 COX-2 inhibitors analyzed, the following 9 medications were found to increase the risk of admission:

  • Diclofenac
  • Ibuprofen
  • Indomethacin
  • Ketorolac
  • Naproxen
  • Nimesulide
  • Piroxicam
  • Etoricoxib
  • Rofecoxib

Very high doses (2 or more daily dose equivalents) of diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib doubled the risk of admission. There was also an increased risk for medium doses (0.9-1.2 daily dose equivalents) of indomethacin and etoricoxib.

However, when taken at commonly used doses, celecoxib did not increase the risk for heart failure.

“The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent,” the researchers concluded.

“This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.”

—Amanda Balbi

Reference:

Arfè A, Scotti L, Varas-Lorenzo C, et al; Safety of Non-steroidal Anti-inflammatory Drugs (SOS) Project Consortium. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study [published online September 28 2016]. BMJ. http://dx.doi.org/10.1136/bmj.i4857.