Popular Medicines Including Ibuprofen and Naproxen Have Been Linked to Heart Failure in Diabetics



Short-term use of non-steroidal anti-inflammatory medicines (NSAIDs) is associated with a first-time heart failure hospitalization in people with type 2 diabetes, according to a study presented at ESC Congress 2022.

The most popular type of anti-inflammatory drug is NSAIDs. The most widely used NSAIDs are aspirin, ibuprofen (often referred to as Advil), and naproxen (known by the brand name Aleve and Naprosyn). Nevertheless, some medications can have negative effects while being widely used.

According to the first author, Dr. Anders Holt of Copenhagen University Hospital in Denmark, one in six patients with type 2 diabetes used at least one NSAID prescription within a year of the study. "In general, we always advise patients to speak with their physician before beginning a new medicine, and given the findings from this study, we hope to assist physicians in reducing risk when prescribing NSAIDs.

There aren't enough data on people with type 2 diabetes, however NSAID use has been associated with an increased risk of heart failure in the general population. Since type 2 diabetics are more likely to have heart failure than people without the condition, NSAIDs may be much more dangerous in these individuals.

In a countrywide population of type 2 diabetes patients, this study examined the association between short-term NSAID use and the risk of first-time heart failure hospitalization. In order to find persons with type 2 diabetes who were diagnosed between 1998 and 2021, the researchers examined Danish registries. Patients who required long-term NSAID therapy due to rheumatological disease or heart failure were not eligible.

Information on prescriptions for oral NSAIDs (celecoxib, diclofenac, ibuprofen, and naproxen) was acquired prior to the first heart failure hospitalization. A case-crossover method was used to investigate the relationships between short-term NSAID use and the likelihood of being admitted to the hospital for the first time due to heart failure. Each patient acted as their own control in this method.

331,189 participants with type 2 diabetes were included in the study. There were 44% women and a 62-year-old median age. 16% of patients reported at least one NSAID prescription during the first year following study enrollment, and 3% reported at least three prescriptions. 12.2% of patients utilized ibuprofen, 3.3% used diclofenac, 0.9% used naproxen, and 0.4% used celecoxib. A total of 23,308 patients experienced their first heart failure hospitalization throughout the course of a median follow-up of 5.85 years.

An increased likelihood of hospitalization for the first time due to heart failure was linked to NSAID use, with an odds ratio (OR) of 1.43 (95% confidence interval [CI] 1.27-1.63). Diclofenac or ibuprofen use was associated with a higher risk of heart failure hospitalization when specific NSAIDs were examined separately; the corresponding ORs were 1.48 (95% CI 1.10-2.00) and 1.46 (95% CI 1.26-1.69), respectively. Celecoxib and naproxen were not linked to an elevated risk, possibly as a result of the low number of reported prescriptions.

The risk of heart failure associated with the use of NSAIDs in patient subgroups was also examined by the researchers. Patients with normal glycated hemoglobin (HbA1c) values (below 48 mmol/mol), a sign of well-controlled diabetes, showed no connection. Those over 65 years old showed strong relationships, however patients under 65 years old showed no associations. The strongest correlation was discovered among very infrequent or new NSAID users.

Dr. Holt pointed out that the study did not contain information on the usage of NSAIDs purchased over the counter. However, he added: "This was a constraint, but it probably had no effect on the results given that a prior analysis revealed that over-the-counter NSAIDs make up a minor part of overall use."

"We cannot conclude that NSAIDs cause heart failure in patients with type 2 diabetes, because this was an observational study," he said in his conclusion. The findings do, however, imply that when considering the use of these drugs, a potential elevated risk of heart failure should be taken into account. For patients under 65 and those with well-controlled diabetes, however, the statistics suggest that it may be safe to give short-term NSAIDs.

Funders include the Danish Heart Foundation, Ib Mogens Kristiansens Almene Fond, Helsefonden, Snedkermester Sophus Jacobsen and hustru Astrid Jacobsen Fond, Marie og M.B. Richters Fond, and Dagmar Marshalls Fond. None of the funding have had any impact on how this study was conducted.

All authors declare that they have not received financial support from any organizations for the work they have submitted, have had no financial relationships with any organizations that might be interested in the work they have submitted in the last three years, and have engaged in no other activities that might be perceived as having influenced the work they have submitted.

By EUROPEAN SOCIETY OF CARDIOLOGY 

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