Research from the University of Copenhagen shows a link between use of common non-steroidal anti-inflammatory drugs (NSAIDs) and hospitalization for heart failure in patients with type 2 diabetes.
In a presentation at the 2022 European Society of Cardiology conference in Barcelona, the Danish team revealed that patients who took ibuprofen or diclofenac had a 30% increase in risk of being hospitalized for heart failure in the next 28 days compared to those not taking these drugs.
“In our study, approximately one in six patients with type 2 diabetes claimed at least one NSAID prescription within one year,” said first author of the abstract, Anders Holt of Copenhagen University Hospital, Denmark, in a press statement.
“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.”
Individuals with type 2 diabetes have greater risk of developing a number of cardiovascular conditions, including heart failure, compared with the overall population. Abnormal fluid retention is a contributing factor to heart failure and also a lesser-known side effect of NSAID use.
To assess the impact of NSAID use on heart failure in individuals with type 2 diabetes, Holt and colleagues used nationwide Danish health registers to identify 334,950 patients diagnosed with type 2 diabetes between 1998 and 2018. These individuals were followed up starting 120 days after diagnosis and participants in the study did not have prior heart failure and were not long-term NSAID users.
NSAID use was measured using prescriptions. Celecoxib and naproxen were only used rarely, but diclofenac (4.9% cohort) and ibuprofen (15.5% cohort) were claimed at least once within a year of follow up. Total follow-up time was a median of 5.85 years and during that time 23,308 participants were hospitalized with heart failure for the first time.
New-onset heart failure hospitalization was 30% more likely in those who had taken ibuprofen or diclofenac, but not celecoxib or naproxen, within the last 28 days.
When the population was broken down into subgroups, no association with heart failure hospitalization was found in those with well controlled blood glucose. The association was strong in those over the age of 65 years and disappeared when only individuals younger than 65 years were included in the analysis. The link between NSAID use and heart failure was also strongest in those who were new or very infrequent users of these drugs.
Holt concedes that the study was observational and cannot prove a definite link between NSAID use and heart failure in this high-risk group. “However, the results suggest that a potential increased risk of heart failure should be taken into account when considering the use of these medications. 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.”
