Even the short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is associated with a heightened risk of heart failure (HF) issues among patients with type 2 diabetes (T2D), according to new research published in the Journal of the American College of Cardiology.[1] The effect appears to be even greater for patients 80 years old and older.
“Cardiovascular risk—and, specifically, the risk of HF associated with use of NSAIDs—is well-described; however, specific recommendations for short-term use in patients with T2DM, along with exploration of proposed mechanisms, are scarce,” wrote Anders Holt, MD, a cardiologist at Copenhagen University Hospital in Denmark, and colleagues. “With NSAIDs being among the most used prescription and over-the-counter drugs worldwide and an increasing prevalence of T2D, the implications for a potential health concern are worrying.”
Holt et al. examined data from more than 331,000 Danish patients diagnosed with T2D from 1998 to 2021. All patients had no prior history of HF or rheumatic disease. None of them had used NSAIDs for 120 days prior to their diagnosis. The median patient age was 62 years old, and 44.2% were women.
Overall, 16% of patients had at least one NSAID prescription within one year of diagnosis. NSAIDs prescribed to these patients included ibuprofen, diclofenac, naproxen and celecoxib.
More than 23,000 patients were hospitalized for first-time HF. The median age of these patients was 76 years old, 39.3% of patients were women and the median time to hospitalization was nearly six years.
Overall, NSAID use was linked to a significant risk of first-time HF hospitalization among this cohort of T2D patients. This was primarily due to events related to the use of ibuprofen or diclofenac; “few events” could be connected to the use of naproxen or celecoxib.
The team’s analysis focused on three exposure windows—14 days, 28 days and 42 days—and this connection between NSAID use and first-time HF hospitalization was present for all three. Also, subgroups where this relationship was seen the most included patients 80 years and older, patients with elevated hemoglobin A1c levels and patients who had not previously used NSAIDs. For other subgroups—patients younger than 65 years old, for instance—no connection was seen between NSAID use and the risk of first-time HF hospitalization.
“The known implications of NSAID use on cardiovascular disease have already resulted in relative contraindications for patients with known cardiovascular disease; however, clear guidelines are missing for patients with T2D, despite a well-defined theoretical risk,” the authors wrote. “This study both shows that magnitude of NSAID use is not negligible among patients with T2DM and that even short-term use of NSAIDs was associated with an elevated risk of first-time HF hospitalization.”
Holt et al. emphasized that “individual risk assessments” are advised when clinicians are considering prescribing NSAIDs to a patient with T2D. The team also noted that more NSAID alternatives are needed that can help patients receive the care they need without increasing their risk of HF.
Read the full analysis here in the Journal of the American College of Cardiology, a publication from the American College of Cardiology.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.