Nonsteroidal antiinflammatory drugs as a trigger of clinical heart failure

Two recent studies estimated that users of nonsteroidal antiinflammatory drugs (NSAIDs) have a two-fold increase in risk of hospitalization for congestive heart failure and that this effect is larger among patients with preexisting cardiovascular diseases.

To evaluate the association between NSAID use and the risk of first-diagnosed episode of heart failure, we conducted a case-control study nested in a population-based cohort of individuals 40-84 years of age and registered in the U.K. General Practice Research Database at 1 January 1996. We excluded patients with a diagnosis of heart failure or cancer before that time and followed source members until a first-time recorded diagnosis of heart failure or cancer, or until 31 December 1996 if no disease occurred. The analysis included 857 confirmed cases and 5000 controls frequency-matched to cases by age (interval of 1 year) and sex.

The estimated adjusted relative risk of heart failure associated with prescription of NSAIDs was 1.6 (95% confidence interval = 1.2-2.1). The relative risk was greater during the first month of therapy and was independent of treatment indication. The relative risk was 1.9 (1.3-2.8) among patients with prior history of hypertension, diabetes or renal failure and 1.3 (0.9-1.9) among individuals without these conditions.

Initiation of NSAID therapy may double the risk of developing heart failure in susceptible individuals. Patients with renal failure, diabetes or hypertension when taking NSAIDs might be at a greater risk of developing heart failure than patients without those conditions.