Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Although dentists should be aware of the link, the association between NSAIDs and heart failure should not be of concern in their practice.

Main

Arfè A, Scotti L et al. BMJ 2016; 354: i4857

Among other conditions, diclofenac is contra-indicated in those with ischaemic heart disease and used with caution in those with a history of cardiac failure. NSAIDs should be avoided in those that have a hypersensitivity reaction, and used with caution in the elderly, pregnant women, nursing mothers and those taking oral anticoagulants. This was a nested case-control study (more efficient than a case-cohort design in that only a subset of controls is compared to the incident cases). In this study, 92,163 hospital admissions for heart failure were identified and matched with 8,246,403 controls. The investigators looked for association between risk of hospital admission for heart failure and use of NSAIDs. The use of any NSAID in the preceding 14 days was associated with a 19% increase of risk of hospital admission for heart failure (odds ratio 1.19; 95% confidence interval 1.17 to 1.22). The risk was greatest for those who took daily, an NSAID in high doses. Although the investigators only looked at those NSAIDs that had been prescribed, this association 'might apply to NSAIDs obtained over the counter'.