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NSAIDs and Heart Failure in Patients With Type 2 Diabetes
Quick Takes
- An elevated risk of HF is seen with short-term NSAID use and first-time HF hospitalization.
- The risk was greatest among older patients, patients with elevated HbA1c levels, and new users of NSAIDs.
- These findings can help physicians mitigate risk when prescribing NSAIDs for patients with T2DM with improved vigilance and closer follow-up of the high-risk groups identified in this analysis.
Study Questions:
What is the impact of short-term nonsteroidal anti-inflammatory drug (NSAID) use on subsequent development of incident heart failure (HF) in patients with type 2 diabetes mellitus (T2DM)?
Methods:
The investigators identified patients diagnosed with T2DM during 1998–2021 and included patients without prior HF, rheumatic disease, or NSAID use 120 days prior to diagnosis using nationwide Danish registers. Associations between NSAIDs and first-time HF hospitalization were investigated using a case-crossover design with 28-day exposure windows and odds ratios (ORs) with 95% confidence intervals (CIs) reported. To investigate any differences in long-term prognosis following first-time HF hospitalization between “NSAID-associated” HF and HF without prior NSAID exposure, multivariable Cox regression models estimating 5-year mortality were fitted including predetermined adjustment for sex, age groups, atrial fibrillation, ischemic heart disease, chronic kidney disease, ischemic stroke, hypertension, chronic obstructive pulmonary disease, and cancer (excluding nonmelanoma skin cancer).
Results:
A total of 331,189 patients with T2DM were included (44.2% female, median age of 62 [interquartile range 52–71] years); 23,308 patients were hospitalized with HF during follow-up, and 16% of patients claimed at least one NSAID prescription within 1 year. Short-term NSAID use was associated with increased risk of HF hospitalization (OR, 1.43 [95% CI, 1.27–1.63]), most notably in subgroups with age ≥80 years (OR, 1.78 [95% CI, 1.39–2.28]), elevated glycated hemoglobin (HbA1c) levels treated with 0–1 antidiabetic agent (OR, 1.68 [95% CI, 1.00–2.88]), and without previous NSAID use (OR, 2.71 [95% CI, 1.78–4.23]).
Conclusions:
The authors report that NSAIDs were widely used and associated with an increased risk of first-time HF hospitalization in patients with T2DM.
Perspective:
This analysis reports an elevated risk of HF with short-term NSAID use and first-time HF hospitalization. The risk was greatest among older patients, patients with elevated HbA1c levels, and new users of NSAIDs. Furthermore, the prognosis following incident HF for both NSAID exposed and nonexposed patients was comparable, suggesting that HF associated with use of NSAID is likely more than temporary fluid overload. These findings can help physicians mitigate risk when prescribing NSAIDs for patients with T2DM with improved vigilance and closer follow-up of the high-risk groups identified in this analysis.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension
Keywords: Anti-Inflammatory Agents, Non-Steroidal, Atrial Fibrillation, Diabetes Mellitus, Type 2, Geriatrics, Glycated Hemoglobin A, Heart Failure, Hypertension, Hypoglycemic Agents, Ischemic Stroke, Metabolic Syndrome, Myocardial Infarction, Myocardial Ischemia, Neoplasms, Pharmacoepidemiology, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Renal Insufficiency, Chronic, Rheumatic Diseases, Risk
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