Short-term use of NSAIDs linked to first hospitalization for heart failure in patients with type 2 diabetes

Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with first hospitalization for heart failure in patients with type 2 diabetes, according to a study presented at the ESC 2022 congress.

In our study, approximately one in six patients with type 2 diabetes requested at least one NSAID prescription during the year. In general, we always recommend that patients consult their doctor before starting any new medication, and with the results of this study, we hope to help doctors mitigate the risks if they prescribe NSAIDs. »

Dr Anders Holt, first author, Copenhagen University Hospital, Denmark

The use of NSAIDs has previously been associated with an increased risk of heart failure in the general population, but data are lacking in patients with type 2 diabetes. Since patients with type 2 diabetes have more Twice as likely to develop heart failure as those without diabetes, NSAIDs could be even more detrimental in this risk group.

This study examined the association between short-term NSAID use and the risk of first hospitalization for heart failure in a nationwide cohort of patients with type 2 diabetes. The researchers used Danish registries to identify patients diagnosed with type 2 diabetes between 1998 and 2021. Patients with heart failure or a rheumatological condition requiring long-term use of NSAIDs were excluded. Information was collected on the prescriptions of oral NSAIDs (celecoxib, diclofenac, ibuprofen and naproxen) claimed before a first hospitalization for heart failure. Using a case-crossover design in which each patient acted as their own control, associations between short-term NSAID use and the risk of hospitalization for heart failure for the first time were assessed.

The study included 331,189 patients with type 2 diabetes. The average age was 62 years and 44% were women. During the first year following inclusion in the study, 16% of patients requested at least one NSAID prescription while 3% requested at least three prescriptions. Ibuprofen was used by 12.2% of patients, diclofenac by 3.3%, naproxen by 0.9% and celecoxib by 0.4%. During a median follow-up of 5.85 years, 23,308 patients were hospitalized for heart failure for the first time.

NSAID use was associated with a high risk of first hospitalization for heart failure, with an odds ratio (OR) of 1.43 (95% confidence interval [CI] 1.27–1.63). When individual NSAIDs were analyzed separately, the risk of hospitalization for heart failure was increased after the use of diclofenac or ibuprofen, with corresponding ORs of 1.48 (95% CI 1.10-2.00 ) and 1.46 (95% CI 1.26-1.69), respectively. Celecoxib and naproxen were not associated with an increased risk, potentially due to the low proportion of prescriptions requested.

The researchers also analyzed the risk of heart failure with the use of NSAIDs in subgroups of patients. No association was found in patients with normal glycated hemoglobin (HbA1c) levels (less than 48 mmol/mol), indicating well-controlled diabetes. Strong associations were found in patients over 65 years of age, while no association was found in those under 65 years of age. The strongest association was found in very infrequent or new users of NSAIDs.

Dr. Holt noted that data on the use of over-the-counter NSAIDs was not included in the study. But he said: “This was a limitation but probably had no impact on the results since a previous report found that over-the-counter NSAIDs accounted for a small proportion of total use.”

He concluded: “This was an observational study and we cannot conclude that NSAIDs cause heart failure in patients with type 2 diabetes. However, the results suggest that a potential increased risk of heart failure should be taken into account when considering the use of these drugs. On the contrary, the data indicate that it may be safe to prescribe short-term NSAIDs to patients younger than 65 and to those with well-controlled diabetes.”

Source:

European Society of Cardiology

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