Short-term NSAID use may increase risk for first-time HF hospitalization in diabetes
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An analysis of Danish registry data show that NSAID use, even for a short time, could raise risk for new-onset HF hospitalization among adults with type 2 diabetes, researchers reported at the European Society of Cardiology Congress.
“According to data from this study, even short-term NSAID use — within 28 days — in adults with type 2 diabetes is associated with an increased risk for first-time HF hospitalization,” Anders Holt, MD, a doctoral student with the department of cardiology at Copenhagen University Hospital, Herlev and Gentofte, Denmark, and the department of epidemiology and biostatistics at the University of Auckland School of Population Health, told Healio. “Further, it seems that patients aged 78 years and older or with an elevated HbA1c level, along with new users of NSAIDs, are particularly susceptible.”
In a retrospective study, Holt and colleagues analyzed data from 331,189 adults diagnosed with type 2 diabetes but without prior HF or a rheumatological condition between 1998 and 2018. Follow-up began 120 days after a first-time diabetes diagnosis. Researchers assessed associations between NSAID use, including celecoxib, diclofenac, ibuprofen and naproxen, and new-onset HF hospitalization among adults claiming at least one, two, three or four prescriptions for NSAIDs within 1 year of initiation of follow-up. Researchers used a case-crossover design, using each person as his or her own control. The mean age of the cohort was 62 years and 44.2% were women.
Prescriptions for diclofenac and ibuprofen were claimed at least once within 1 year from the beginning of follow-up by 3.3% and 12.2% of patients, respectively, with 0.5% and 2% claiming at least for prescriptions of each.
Using 28-day exposure windows, risk for new-onset HF hospitalization increased after use of diclofenac (OR = 1.5; 95% CI, 1.1-2) and ibuprofen (OR = 1.5; 95% CI, 1.3-1.7). There were no associations found between HF hospitalization risk and use of celecoxib or naproxen, which were rarely used.
In analyses stratified by age and diabetes status, researchers found no association for NSAID use and HF hospitalization among adults aged 65 years and younger or with normal HbA1c levels, Holt said.
“Overall, even short-term NSAID treatment should be discouraged in patients with type 2 diabetes,” Holt told Healio. “However, it could be safe — from these data — to treat younger patients with well-controlled type 2 diabetes. Individual assessment, taking age and type 2 diabetes treatment status into account, is advised if NSAIDs are used in patients with type 2 diabetes.”
In a press release, Holt said data on over-the-counter use of NSAIDs were not included in the study but added that limitation likely had no impact on the results, as previous data suggest over-the-counter NSAIDs comprise a small proportion of total use.
Holt said more the mechanism behind the possible association is not known.
“Clinical trials investigating this question would probably not be ethically sound, but I would like to see more research directed at the mechanisms behind these proposed associations,” Holt told Healio.
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Holt A, et al. Abstract Number or Session Name. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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