Common painkillers linked to increased risk of heart failure, BMJ finds

[Gert van der Hoek]

[FONT=&quot]Wednesday 28 September 2016[/FONT]

[FONT=&quot]Anti-inflammatory drugs such as ibuprofen add to dangers, particularly in the elderly, study of 10 million users concludes[/FONT]

[FONT=&quot]Common painkillers such as ibuprofen used by millions of people in the UK are linked to an increased risk of heart failure, experts have said.[/FONT]
[FONT=&quot]Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) could increase the risk of being admitted to hospital. Previous studies have linked the drugs to abnormal heart rhythm – which can cause heart failure – and an increased risk of heart attack and stroke if taken regularly.[/FONT]

[FONT=&quot]The drugs, together with a subgroup of anti-inflammatories known as selective COX-2 inhibitors, are used to control pain and inflammation and are commonly taken by people with arthritis.[/FONT]

[FONT=&quot]The study, published in the British Medical Journal, used data for almost 10 million NSAIDs users from the UK, the Netherlands, Italy and Germany, who started treatment between 2000 and 2010. Overall, 92,163 hospital admissions for heart failure were identified among the group.

The risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). The increased risk of hospital admission ranged from 16% for naproxen to 83% for ketorolac.[/FONT]
[FONT=&quot]Researchers also found the risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses, although they stressed this should be interpreted with caution.[/FONT]


[FONT=&quot]Even medium doses of indomethacin and etoricoxib were associated with increased risk, the study said, but there was no evidence that celecoxib increased the risk of admission for heart failure at commonly-used doses.[/FONT]

[FONT=&quot]The study found that people who had taken any NSAID in the previous 14 days had a 19% increased risk of hospital admission for heart failure compared with people who had used NSAIDs at any point in the past. The BMJ research was led by a team from the University of Milano-Bicocca in Italy.[/FONT]

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[Gert van der Hoek]

Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study

BMJ2016; 354doi: http://dx.doi.org/10.1136/bmj.i4857 (Published 28 September 2016)

Abstract

Objectives To investigate the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) and estimate the risk of hospital admission for heart failure with use of individual NSAIDs.

Design Nested case-control study.

Setting Five population based healthcare databases from four European countries (the Netherlands, Italy, Germany, and the United Kingdom).

Participants Adult individuals (age ≥18 years) who started NSAID treatment in 2000-10. Overall, 92 163 hospital admissions for heart failure were identified and matched with 8 246 403 controls (matched via risk set sampling according to age, sex, year of cohort entry).

Main outcome measure Association between risk of hospital admission for heart failure and use of 27 individual NSAIDs, including 23 traditional NSAIDs and four selective COX 2 inhibitors. Associations were assessed by multivariable conditional logistic regression models. The dose-response relation between NSAID use and heart failure risk was also assessed.

Results Current use of any NSAID (use in preceding 14 days) was found to be associated with a 19% increase of risk of hospital admission for heart failure (adjusted odds ratio 1.19; 95% confidence interval 1.17 to 1.22), compared with past use of any NSAIDs (use >183 days in the past). Risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). Odds ratios ranged from 1.16 (95% confidence interval 1.07 to 1.27) for naproxen to 1.83 (1.66 to 2.02) for ketorolac. Risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses (≥2 defined daily dose equivalents), although some confidence intervals were wide. Even medium doses (0.9-1.2 defined daily dose equivalents) of indomethacin and etoricoxib were associated with increased risk. There was no evidence that celecoxib increased the risk of admission for heart failure at commonly used doses.

Conclusions The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent. This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.

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