Short-term NSAIDs use ups risk of heart failure in patients with type 2 diabetes: JACC

Patients with increased HbA1c levels, advanced age, and new users of NSAID appeared to be more susceptible. The findings, published in the Journal of the American College of Cardiology and presented at the European Society of Cardiology annual congress, could guide physicians in prescribing NSAIDs.

According to the study, short-term use of NSAIDs among over 300,000 patients with type 2 diabetes was associated with a relative 43% increased risk of a first-time heart failure hospitalization in the subsequent 28 days (OR 1.43).

Endothelial dysfunction and fluid retention have been related to NSAID use, and type 2 diabetes has been linked to both subclinical cardiomyopathy and a decline in kidney function.

Anders Holt, Copenhagen University Hospital–Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark, and colleagues hypothesized that short-term NSAID use could lead to subsequent development of incident heart failure in type 2 diabetes patients.

For this purpose, the researchers identified patients with type 2 diabetes diagnosis from 1998 to 2021 using nationwide Danish registers. They included patients without previous rheumatic disease, heart failure, or NSAID use 120 before the diagnosis. The authors deployed a case-crossover design with 28-day exposure windows to investigate associations between NSAIDs and first-time HF hospitalization.

The authors reported the following findings:

• Three hundred thirty-one thousand one hundred eighty-nine patients with type 2 diabetes were included: 44.2% female, the median age of 62 years; 23,308 patients were hospitalized with HF during follow-up, and 16% of patients claimed at least 1 NSAID prescription within one year.
• Short-term use of NSAIDs was associated with increased risk of HF hospitalization (OR: 1.43), most notably in subgroups with age ≥80 years (OR: 1.78), elevated haemoglobin (Hb) A1c levels treated with 0 to 1 antidiabetic drug (OR: 1.68), and without previous use of NSAIDs (OR: 2.71).
• Naproxen and celecoxib were rarely used (0.9% and 0.4%, respectively), while 12.2% of patients took ibuprofen or 3.3% diclofenac. The latter two NSAIDs had ORs of 1.46 and 1.48 for hospitalization for new-onset heart failure using 28-day exposure windows. No increased risk emerged for celecoxib or naproxen.

"In patients with type 2 diabetes, NSAIDs were widely used and were linked with an increased risk of first-time HF hospitalization," the researchers wrote. "Patients with elevated HbA1c levels, advanced age, and new users of NSAID seemed more susceptible."

"These findings could guide physicians prescribing NSAIDs," they concluded.

Reference:

Holt A, Strange JE, Nouhravesh N, Nielsen SK, Malik ME, Schjerning AM, Køber L, Torp-Pedersen C, Gislason GH, McGettigan P, Schou M, Lamberts M. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023 Apr 18;81(15):1459-1470. doi: 10.1016/j.jacc.2023.02.027. PMID: 37045515.