NSAID use linked to risk of heart failure hospitalization in type 2 diabetes
Danish patients with type 2 diabetes who took prescription NSAIDs had increased risk of first-time heart failure hospitalization, particularly if they were new users of the drugs or age 65 years or older, a recent study found.
Even short-term NSAID use is associated with increased risk of first-time heart failure (HF) hospitalization among patients with type 2 diabetes, a recent study found.
Researchers used nationwide Danish registers to identify patients diagnosed with type 2 diabetes during 1998 to 2021. Included patients had no HF diagnosis, rheumatic disease, or use of prescription NSAIDs 120 days before diabetes diagnosis. The primary exposure was a filled prescription of celecoxib, diclofenac, ibuprofen, or naproxen within 28 days before first-time HF hospitalization. The researchers also looked at 14- and 42-day exposure windows. Results were published April 10 by the Journal of the American College of Cardiology.
The final study cohort included 331,189 patients with type 2 diabetes. Within the first year after inclusion, 16% of patients filled at least one NSAID prescription (ibuprofen, 12.2%; diclofenac, 3.3%; naproxen, 0.9%; and celecoxib, 0.4%), with 3% filling at least three prescriptions within a year. During follow-up, 23,308 patients had a first-time HF hospitalization (median age, 76 years; 39.3% female), with a median time to event of 5.9 years. Previous NSAID exposure was associated with increased first-time HF hospitalization risk, regardless of exposure window (odds ratios, 1.41 [95% CI, 1.20 to 1.65] for 14-day exposure; 1.43 [95% CI, 1.27 to 1.63] for 28-day exposure; and 1.36 [95% CI, 1.22 to 1.53] for 42-day exposure). Use of ibuprofen and diclofenac were the main drivers of the effect, due to rare use of naproxen and celecoxib. The strongest association was found in new users who had not previously filled prescriptions for NSAIDs. There were also stronger associations between NSAIDs and HF hospitalization in patients age 65 years and older, whereas no association was found for patients younger than age 65 years. There was also an increased association in the subgroup concomitantly treated with renin-angiotensin system inhibitors or diuretics, although no additive effect was seen in the group concomitantly treated with both.
Limitations of the study include its observational design and a lack of data on over-the-counter use of NSAIDs, the authors noted. They added that the case-crossover design did not allow for a stratification by NSAID dosage.
“The increased risk of HF associated with the short-term use of NSAIDs in patients with [type 2 diabetes] is indeed worrying given that they are common and easily accessible and are used to treat pain in a variety of medical conditions,” an accompanying editorial said. Clinical trial evidence replicating these results would be needed to potentially change guidelines; in the meantime, clinicians should realize that short- or long-term NSAID use may be detrimental to cardiovascular health, the editorialists noted.