Risk for HF hospitalization varies between individual NSAIDs

New research published in the British Medical Journal highlights increased risk for HF hospitalization with use of several commonly used nonsteroidal anti-inflammatory drugs and selective Cox-2 inhibitors.

Researchers conducted a nested case-control study of five population-based healthcare databases in Germany, Italy, the Netherlands and the United Kingdom. The researchers analyzed data on adults aged 18 years and older who initiated NSAID or Cox-2 inhibitor treatment from 2000 to 2010.

During this period, the overall hospital admission rate for HF was 92,163; this was matched with 8,246,403 controls matched for age, sex and year of cohort entry, according to the study details.

The researchers assessed risk for HF hospital admission and use of 23 NSAIDs and four selective Cox-2 inhibitors. The mean age of NSAID/Cox-2 inhibitor users was 77 years and the mean age among controls was 76 years.

Users of NSAIDs within the previous 14 days had a 19% higher risk for HF hospitalization compared with those who used NSAIDs more than 183 days in the past (adjusted OR = 1.19; 95% CI, 1.17-1.22), according to a pooled analysis.

Compared with past use, current use of the following NSAIDs and Cox-2 inhibitors, in particular, were associated with increased risk for HF hospitalization:

diclofenac;

ibuprofen;

indomethacin;

ketorolac;

naproxen;

nimesulide;

piroxicam;

etoricoxib

rofecoxib

According to the findings, the ORs for HF hospitalization ranged from 1.83 (95% CI, 1.66-2.02) for ketorolac use to 1.16 (95% CI, 1.07-1.27) for naproxen use.

The risk for HF was two times as high with doses of two or more times the daily dose equivalent of diclogenac, etoricoxib, indomethacin, piroxicam and rofecoxib. The researchers also found similarly increased risk with moderate doses (0.9 to 1.2 defined daily dose equivalents) of etoricoxib and indomethacin, according to the findings. Commonly used doses of celecoxib did not appear to increase the risk for HF hospitalization.

“The risk of hospital admission for HF associated with current use of NSAIDs appears to vary between individual NSAIDs and this effect is dose dependent,” Andrea Arfè, PhD, from the Unit of Biostatistics, Epidemiology and Public Health at University of Milano-Bicocca, Milan, Italy, and colleagues wrote. “This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.”– by Dave Quaile

Disclosure: The researchers report receiving funding from the European Community’s seventh Framework Program.