News:Increased Mortality and Cardiovascular Morbidity Associated with the Use of Nonsteroidal Anti-Inflammatory Drugs in Chronic Heart Failure
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Increased mortality and cardiovascular morbidity associated with the use of nonsteroidal anti-inflammatory drugs in chronic heart failure.
February 6, 2009 By Michael W Tempelhof, MD [1]
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors in patients with known cardiovascular disease has been demonstrated to increase the risk for cardiovascular events and mortality. NSAIDS and COX-2 inhibitors have been associated with increased retention of sodium retention, endothethial dysfunction and renal toxicity. Consequently, the administration of these agents to patients with heart failure is not recommended.
OBJECTIVE:
To asses the risk of death and hospitalization secondary to myocardial infarction and heart failure associated with the use of NSAIDs in patients with known heart failure.
METHODS:
107,092 patients with known heart failure where assessed for exposure to NSAIDs since their previous hospitalization. After adjustment for potential confounding factors, the risks for death, hospitalization for MI, and hospitalization from heart failure were assessed and correlated to specific NSAID agents.
RESULTS:
One-third of the patient cohort received at least 1 prescription of an NSAID following hospital discharge. 60,974 (56.9%) died, and 8970 (8.4%) and 39,984 (37.5%) were hospitalized with myocardial infarction or HF, respectively. The hazard ratio (95% confidence interval) for death was 1.70 (1.58-1.82), 1.75 (1.63-1.88), 1.31 (1.25-1.37), 2.08 (1.95-2.21), 1.22 (1.07-1.39), and 1.28 (1.21-1.35) for rofecoxib, celecoxib, ibuprofen, diclofenac, naproxen, and other NSAIDs, respectively.
The risk of death and risk of hospitalization from myocardial infarction and HF were associated with NSAID use in a dose-dependent relationship.
CONCLUSIONS:
NSAIDs for analgesic therapy in patients with HF are associated with increased risk of death and cardiovascular events. These results support current guideline recommendations to avoid NSAIDs in heart failure patients and underscores the importance of precarious risk benefit analysis for these patients.
Gislason GH et al. Increased mortality and cardiovascular morbidity associated with the use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med 2009 Jan 26; 169:141.
