NSAIDs Linked to Thousands of Heart Failure Hospitalizations Among Patients With Type 2 Diabetes

A study published by the European Society of Cardiology indicates a strong association between short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and first-time heart failure hospitalizations in patients with type 2 diabetes. Patients 65 years of age and older experienced high rates of hospitalizations, whereas infrequent/new NSAID users were found to have the greatest risk.

“In our study, approximately 1 in 6 patients with type 2 diabetes claimed at least one NSAID prescription within 1 year,” said author Dr. Anders Holt of Copenhagen University Hospital, Denmark, in a press release. ”In general, we always recommend that patients consult their doctor before starting a new medication, and with results from this study we hope to help doctors mitigate risk if prescribing NSAIDs.”

Patients with type 2 diabetes are twice as likely to suffer from heart failure than non-diabetics. Although previous evidence shows that NSAIDs increase heart failure risk in the general population, it stands to reason that NSAIDs could pose a greater risk for the type 2 diabetes population; however, research on the relationship between NSAIDs and type 2 diabetes is limited, according to the investigators.

Holt and team sought to analyze the risk of hospitalization among patients with type 2 diabetes due to heart failure because of short-term NSAID use. Turning to Danish registrars, the team identified 331,189 patients who were diagnosed with type 2 diabetes from 1998 to 2021. The average age of the patient was 62 years, and the study was comprised of 44% women.

Patients who required long-term NSAIDs were not included in the study. Prescription oral NSAIDs included celecoxib, diclofenac, ibuprofen, and naproxen taken prior to a heart failure event.

The research team implemented a case-crossover design. After 1 year, 16% of patients proclaimed that they were on 1 NSAID prescription, and 3% reported taking at least 3 prescriptions. Ibuprofen was the most common NSAID and was used by 12.2% of patients, followed by diclofenac at 3.3%. Fewer than 1% of patients took naproxen or celecoxib.

NSAID use among type 2 diabetics was associated with a greater risk of hospitalization from first-time heart failure, with 23,308 patients hospitalized with first-time heart failure after an approximate 6-year median follow up.

NSAID had an odds ratio (OR) of 1.43, but the risk of heart failure hospitalization was worse for patients on ibuprofen (OR of 1.48) and diclofenac (OR of 1.46). Naproxen or celecoxib showed no increased risk, though the team suggests it could be due to fewer prescriptions.

Among patient subgroups, patients with normal glycated hemoglobin (HbA1c) levels had no association with increased hospitalization from first-time heart failure. Patients aged 65 years and older had a strong association, but the strongest association was observed in patients who infrequently used NSAIDs, and new users.

Researchers cannot conclude that NSAIDs causes heart failure because it was an observational study. The study was also limited because researchers did not include data on OTC NSAID use.

“The results suggest that a potential increased risk of heart failure should be taken into account when considering the use of these medications,” Holt said in the press release. “On the contrary, the data indicate that it may be safe to prescribe short-term NSAIDs for patients below 65 years of age and those with well-controlled diabetes.”

Reference

European Society of Cardiology. Non-steroidal anti-inflammatory drugs linked with heart failure in patients with diabetes. EurekAlert! August 23, 2022. Accessed on August 23, 2022. https://www.eurekalert.org/news-releases/962235