A recent study suggests that infrequently taking nonsteroidal anti-inflammatory drugs, especially ibuprofen, in type 2 diabetes may increase the risk of heart failure and hospitalization.
A study published by the European Society of Cardiology points to a strong association between short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and first hospital admissions for heart failure in patients with type 2 diabetes. Patients aged 65 years and older had high hospitalization rates, while infrequent/new NSAID users were most at risk.
“In our study, about 1 in 6 patients with type 2 diabetes claimed at least one NSAID prescription within 1 year,” said author Dr. Anders Holt of the University Hospital of Copenhagen, Denmark, in a press release. “In general, we always recommend that patients consult their doctor before starting any new drug, and with the results of this study, we hope to help doctors reduce the risk when prescribing NSAIDs.”
Patients with type 2 diabetes are twice as likely to develop heart failure as non-diabetics. While previous evidence shows that NSAIDs increase the risk of heart failure in the general population, it is obvious that NSAIDs may pose a greater risk to the type 2 diabetes population; however, research on the relationship between NSAIDs and type 2 diabetes is limited, the researchers said.
Holt and team sought to analyze the risk of hospitalization in patients with type 2 diabetes due to heart failure due to short-term use of NSAIDs. The team turned to Danish registrars and identified 331,189 patients diagnosed with type 2 diabetes from 1998 to 2021. The mean patient age was 62 years and the study consisted of 44% women.
Patients requiring long-term NSAIDs were not included in the study. Prescription oral NSAIDs include celecoxib, diclofenac, ibuprofen, and naproxen taken prior to heart failure.
The research team implemented a case-crossover design. After 1 year, 16% of patients stated they used 1 NSAID prescription and 3% reported using at least 3 prescriptions. Ibuprofen was the most common NSAID and was used by 12.2% of patients, followed by diclofenac in 3.3%. Less than 1% of patients were taking naproxen or celecoxib.
The use of NSAIDs in type 2 diabetics was associated with a greater risk of hospitalization for first-time heart failure, with 23,308 patients being first hospitalized after a median follow-up of approximately 6 years.
NSAID had an odds ratio (OR) of 1.43, but the risk of hospitalization for heart failure was greater for patients receiving ibuprofen (OR 1.48) and diclofenac (OR 1.46). Naproxen or celecoxib showed no increased risk, although the team suggests this may be due to fewer prescriptions.
Among the patient subgroups, patients with normal glycated hemoglobin (HbA1c) levels were not associated with increased hospitalizations due to the first heart failure. Patients 65 years and older had a strong association, but the strongest association was seen in patients who rarely used NSAIDs and new users.
Researchers cannot conclude that NSAIDs cause 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 considered when taking these drugs,” Holt said in the press release. “On the contrary, the data indicate that it may be safe to prescribe short-term NSAIDs to patients under the age of 65 and those with well-controlled diabetes.”
European Society of Cardiology. Non-steroidal anti-inflammatory drugs associated with heart failure in patients with diabetes. EurekAlert! August 23, 2022. Accessed August 23, 2022. https://www.eurekalert.org/news-releases/962235