• The short-term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, is linked to hospitalisations for heart failure in patients with type 2 diabetes.
  • In a cohort of over 331,000 people with type 2 diabetes, using NSAIDs increased the risk of hospitalisation for heart failure by 43%.
  • People with type 2 diabetes have twice the risk of heart failure compared to those who don’t have the condition but taking NSAIDs might further increase the risk.

Researchers from Denmark have found an association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with type 2 diabetes and an increased risk of being hospitalised due to heart failure.

The link between popular painkillers such as ibuprofen and diclofenac and heart failure in the general population has previously been explored, according to the study’s authors.

As people with type 2 diabetes have twice the likelihood of developing heart failure than people without the condition, the researchers decided to investigate the use of NSAIDs in the at-risk group.

“In our study, approximately one in six patients with type 2 diabetes claimed at least one NSAID prescription within one year,” said first author Dr. Anders Holt of Copenhagen University Hospital, Denmark. “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.”

Medical register data from 331,189 Danish patients with type 2 diabetes were used in the study. The average age of the participants was 62, and 44% of them were women. 16% of the cohort claimed to have at least one NSAID prescription, with 3% claiming to have three or more total prescriptions.

More than 12% used ibuprofen, 3.3% used diclofenac, 0.9% used naproxen, and 0.4% used celecoxib.

After a follow-up of six years, 23,308 of the initial participants had been admitted to hospital for the first time in their lives. Those who used ibuprofen or diclofenac were almost one and a half times more likely to need hospitalisation for heart failure compared to those who did not use NSAIDs, with odds ratios (OR) of 1.48 and 1.6, respectively.

While celecoxib and naproxen were not associated with an increased risk, the researchers explain that this may be due to the relatively small sample size.

The study also examined the risk of heart failure with NSAID use in subgroups of the cohort. There was no link between patients with HbA1c levels indicative of well-managed diabetes – which is anything below 48 mmol/mol or 6.5%. However, strong associations were identified in patients over 65 years old and in those who were either new to taking NSAIDs or infrequently used them.

Data used in the study only focused on prescribed NSAIDs, with Dr. Holt noting that the study did not include information on over-the-counter use of NSAIDs. “This was a limitation but likely had no impact on the results since a previous report found that over-the-counter NSAIDs comprise a small proportion of total use,” he argued.

“This was an observational study and we cannot conclude that NSAIDs cause heart failure in patients with type 2 diabetes. 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,” Dr Holt concluded.

This abstract, “Risk of heart failure following short-term non-steroidal anti-inflammatory drug use in patients with type 2 diabetes mellitus”, was originally presented at the ESC Congress on the 26th of August, 2022.







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