NSAIDs may lead to increased risk of heart failure

Study results are of concern owing to widespread use of the drugs, say cardiology experts

In a BMJ study based on almost 10 million NSAIDs users across four European countries (the Netherlands, Italy, Germany and the UK), researchers from the University of Milano-Bicocca looked at 23 traditional NSAIDs and four selective COX-2 inhibitors.

Altogether the data included 92,163 hospital admissions for heart failure that were matched with 8,246,403 control patients.

Researchers found that current use (use in the preceding 14 days) of any NSAID was associated with a 19% increased risk of hospital admission for heart failure.

After taking into account influencing factors, the risk of admission increased for seven commonly used NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX-2 inhibitors (etoricoxib and rofecoxib).

The researchers found magnitude of risk varied between individual NSAIDs and according to the dose prescribed.

Risk of admission doubled for diclofenac, etoricoxib, indomethacin, piroxicam and rofecoxib used at very high doses (≥2 defined daily dose equivalents).

While the study was observational and did not provide information on absolute risks, the authors say the results “offer further evidence that the most frequently used individual traditional NSAIDs and selective COX- 2 inhibitors are associated with an increased risk of hospital admission for heart failure.”

“Owing to the widespread use of NSAIDs, even a small increase in cardiovascular risk is a concern for public health,” say two Danish heart experts in a linked editorial.

“NSAIDs are still widely available over the counter in supermarkets and convenience stores without any provision of professional advice on their use or potential adverse effects. This practice further fuels the common misconception that NSAIDs are harmless drugs that are safe for everyone,” write the cardiology professors.

They say tighter regulation on the drugs is justified and “requirements for healthcare professionals providing advice on their use and potential harm is warranted.”

See the full study here, and the linked editorial here.

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Update on NSAIDs: risks and harms (CPD unit)

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