Anti-inflammatory pills tied to heart failure risk

Widely used non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of heart failure— even in people without a history of cardiac issues, a recent study suggests.

Overall, the odds of a hospital admission for heart failure was 19 percent higher for people who used NSAIDs in the previous two weeks than for individuals who didn't take these drugs, the study found.

Not all NSAIDs carry the same risk, however. The increased odds of a heart failure hospitalization were, for example, just 16 percent for naproxen but 83 percent for ketorolac. Many NSAIDs, including celecoxib (Celebrex), were tied to little or no increased risk.

"There is difference between the NSAIDs in risk of heart failure and higher dosages are associated with increased risk," said Dr. Gunnar H. Gislason, chief scientific officer of the Danish Heart Foundation and author of an editorial accompanying the study.

"NSAIDs increase risk of heart failure independent of sex or previous heart failure status," Gislason added by email.

"However, if you have established heart disease, heart failure or carry many cardiovascular risk factors, your risk associated with NSAID use is more pronounced - thus especially the elderly and patients with any heart condition should avoid NSAIDs," Gislason said.

While plenty of previous research has linked NSAIDs to an increased risk of heart failure, the current study sheds new light on the risk of individual drugs in this family of medicines, researchers note in The BMJ.

To assess the cardiovascular safety of these medicines, researchers analyzed data on 27 different NSAIDs taken by adults in the Netherlands, Italy, Germany and the U.K. between 1999 and 2010.

The analysis included more than 92,000 people admitted to the hospital for heart failure and a control group of more than 8.2 million similar individuals without a record of hospitalization for this condition.

A total of 16,081 people, or 17.4 percent, with a heart failure hospitalization were current users of NSAIDs, as were 14.4 percent of the individuals without a this history, the study found.

Nine NSAIDs had a significantly higher risk of heart failure for current users: ketorolac, etoricoxib, indomethacin, rofecoxib, piroxicam, diclofenac, ibuprofen, nimesulide and naproxen.

These nine drugs were associated with an increased risk of heart failure in both men and women and regardless of whether or not there was a previous heart failure diagnosis.

Current users of very high doses of diclofenac, etoricoxib, indomethacin, piroxicam and rofecoxib had more than twice the risk of heart failure than past users, the study also found.

One limitation of the study is that researchers lacked data on over-the-counter NSAID users, which means some patients classified as non-users in the analysis might actually take nonprescription versions of the drugs, particularly ibuprofen, the authors note. This might understate the impact of NSAIDs on heart failure risk.

Another drawback is the potential for some heart failure admissions to be linked to other cardiovascular problems, with hospital discharge records noting a different reason for the admission, the researchers point out.

Even so, the findings add to a growing body of evidence pointing to the risk of heart failure associated with NSAIDS, the authors conclude.

Patients in pain also have other options - such as acetaminophen, known as paracetamol outside the U.S., or a weak opiate - that don't carry the same risk of cardiovascular disease as NSAIDs, Gislason said. Physical therapy, exercise, or weight loss can also help with some situations, he said.

"If you need NSAIDs for pain or arthritis, you should consult your physician who could advise about alternative pain management," Gislason added.