medwireNews: A case-crossover study supports a link between use of non-steroidal anti-inflammatory drugs (NSAIDs) and development of heart failure in people with type 2 diabetes.
The researchers found that people were a significant 1.43-fold more likely to be hospitalized with heart failure within 28 days after receiving a prescription for NSAIDs than during an equivalent period without recorded NSAID use.
NSAID prescriptions were common in the study cohort of 331,189 Danish residents with type 2 diabetes (average age 62 years, 44.2% women), with 16% claiming at least one prescription during the first year after study inclusion – predominantly for ibuprofen (12%) – and 3% claiming at least three prescriptions.
Writing in the Journal of the American College of Cardiology, Anders Holt (Gentofte Hospitalsvej, Hellerup, Denmark) and study co-authors note that they had no information about over-the-counter use of NSAIDs, but cite previous research suggesting “this may be negligible” in Denmark.
The team found a significant association between heart failure hospitalization, which occurred in 23,308 people, and use of ibuprofen (odds ratio=1.46) and diclofenac (odds ratio=1.48), but not for celecoxib or naproxen, although these two were only used by a respective 0.4% and 0.9% of the cohort.
Subgroup analysis found the strongest associations were for people aged at least 65 years and those without a previous NSAID prescription. There were significant associations for people with glycated hemoglobin of at least 48 mmol/mol (6.5%), but not for those with nondiabetic levels, regardless of the number of medications they were taking to achieve this.
The authors of a linked editorial describe the findings as “timely and relevant,” as well as “not unexpected,” given the established links between NSAID use and heart failure and between diabetes and heart failure.
Hassan Khan (Norton Heart Specialists, Louisville, Kentucky, USA) and Setor Kunutsor (University of Leicester, UK) say that the study results are “worrying,” considering how accessible and widely used NSAIDs are, but stress that “it may be premature to issue guideline recommendations based on a single observational study.”
They call for further “robust” evidence and say that, in the meantime, “physicians and patients must weigh the risks and benefits of each agent before choosing a treatment option,” and use NSAIDs at the lowest possible dose and for the shortest length of time.
“Evidence suggests that naproxen may be the NSAID of choice in patients with high cardiovascular risk,” they add.
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