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Non-steroidal anti-inflammatory drugs and cardiac failure: meta-analyses of observational studies and randomised

Paul A Scott1, Gabrielle H Kingsley, David L Scott

  • 1Department of Cardiology, Southampton University Hospital, Southampton, SO16 6YD, UK.

European Journal of Heart Failure
|September 2, 2008
PubMed
Abstract

Insights

Non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiac failure, with similar risks observed for conventional NSAIDs and COX-2 specific NSAIDs (COXIBs). Pre-existing cardiac conditions heighten this risk, though overall risks remain relatively small.

Area of Science:

  • Cardiology
  • Pharmacology
  • Rheumatology

Background:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation.
  • Concerns exist regarding the cardiovascular safety of NSAIDs, particularly COX-2 selective inhibitors (COXIBs).

Purpose of the Study:

  • To evaluate the risks of cardiac failure associated with NSAID use.
  • To specifically assess the cardiac failure risks posed by COXIBs compared to conventional NSAIDs.

Main Methods:

  • Meta-analyses of observational studies (case-control, cohort) and randomized controlled trials (RCTs) were conducted.
  • Systematic searches of electronic databases and bibliographies were performed for studies published between 1997 and 2008.
  • Studies included patients with arthritis and non-rheumatic disorders, comparing NSAIDs to placebo or other NSAIDs.

Main Results:

  • Observational studies indicated a potential increased risk of cardiac failure with NSAIDs.
  • Placebo-controlled trials showed a higher incidence of cardiac failure with NSAIDs.
  • However, RCTs comparing conventional NSAIDs and COXIBs in arthritis patients revealed no significant difference in cardiac failure risk.

Conclusions:

  • Both observational studies and RCTs confirm that NSAIDs elevate the risk of cardiac failure.
  • The overall risk of cardiac failure from NSAIDs is relatively small and comparable between conventional NSAIDs and COXIBs.
  • Individuals with pre-existing cardiac failure face an increased risk when using NSAIDs.

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