Current Use of Prescribed NSAIDs Is Associated with Elevated Risk for Heart Failure

Arfè A et al., BMJ 2016 Sep 28; 354:i4857

Level of risk varied among nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with excess risk for heart failure (HF). In this study, researchers used healthcare databases in four European countries to evaluate the association between NSAID use and hospital admission for HF. Among 7.7 million adults who started treatment with prescription NSAIDs between 2000 and 2010, researchers identified 92,000 cases (mean age, 77) with HF-related hospital admission and matched them by age, sex, and year of study entry with >8 million controls.

Risk for HF-related hospital admission was significantly higher with current NSAID use (i.e., within the previous 14 days) than with prior use (adjusted odds ratio, 1.2). In analyses of individual NSAIDs, current use of seven traditional NSAIDS (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, piroxicam, and nimesulide [not available in the U.S.]) and two cyclooxygenase (COX)-2 inhibitors (etoricoxib [not FDA-approved] and rofecoxib [Vioxx; withdrawn from the market]) was associated with significantly higher risks for hospital admission. Significant dose–response relations were observed for diclofenac, etoricoxib, indomethacin, naproxen, and rofecoxib.

Comment

In this study, current use of many prescribed NSAIDs was associated with elevated risk for HF-related hospital admission. Although these results are subject to confounding, they are biologically plausible: NSAIDs inhibit prostaglandin synthesis and can impair renal function, potentially triggering HF in susceptible people. Notably, some NSAIDs (e.g., ketoprofen) and COX-2 inhibitors (e.g., celecoxib) were not associated with elevated risk.