According to researchers at the University of Milano-Bicocca in Italy, the use of certain nonsteroidal anti-inflammatory drugs (NSAIDs) has been linked to an increased risk of heart failure and hospitalization. The results of the study were published in The BMJ.
Some NSAIDs reduce pain and inflammation by targeting the enzymes COX-1 and COX-2, which trigger the production of inflammation-promoting prostaglandins. According to the researchers, previous studies have identified a link between NSAIDs, including COX-2 inhibitors, and heart failure.
The European Society of Cardiology recommends that NSAIDs should only be prescribed to those with an inherently increased risk of heart failure. If a patient has already been diagnosed with heart failure, they should not use NSAIDs altogether.
“Nevertheless, there is still limited information on the risk of heart failure associated with the use of individual NSAIDs (both COX-2 inhibitors and traditional NSAIDs) in clinical practice, and especially on their dose-response associations,” the authors say in the publication. To further investigate this correlation, the researchers looked at the use and dose data for individual NSAIDs and how they influence hospital admissions due to heart failure.
Five healthcare databases from Germany, Italy, the Netherlands and the UK were accessed by the researchers during the study. In all, 10 million patients using NSAIDs were identified in the datasets, along with over 8 million controls who were not taking the medication.
The use and dose data included 27 different NSAIDs, with four belonging to the COX-2 inhibitor class of drugs. Individuals who had taken NSAIDs in the past two weeks were found to be 19 percent more likely to experience heart failure and be admitted to hospital, compared with patients who had not used the drugs for at least 183 days.
After controlling for other key factors, seven commonly-prescribed NSAIDs – including diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam – were found to raise the risk of hospitalization and heart failure. Etoricoxib and rofecoxib – two COX-2 inhibitors – were also associated with heart failure.
As this study was designed to be observational, the researchers stress that they cannot claim that NSAIDs cause heart failure. Despite this, they still believe their findings have significant clinical implications.
“Our study […] provides evidence that current use of both COX-2 inhibitors and traditional individual NSAIDs are associated with increased risk of heart failure,” write the authors. “Furthermore, the magnitude of the association varies between individual NSAIDs and according to the prescribed dose. Because any potential increased risk could have a considerable impact on public health, the risk effect estimates provided by this study may help inform both clinical practices and regulatory activities.”