Type 2 diabetes patients who take non-steroidal anti-inflammatory drugs (NSAIDs) for short-term relief of pain have a 43% higher risk of developing heart failure with first-time heart failure hospitalization, according to a study published in the Journal of the American College of Cardiology.¹

In this study, Andrew Holt from the Dept. of Cardiology, Copenhagen University Hospital–Herlev and coauthors examined 331,189 patients, aged 52-71 years, diagnosed with type 2 diabetes between 1998 and 2021 using data from Danish registries. The objective of the study was to find out any association between the short-term use of NSAIDs and incident heart failure (HF) in patients with type 2 diabetes. Majority of the participants (~56%) were male. Patients with previously diagnosed heart failure or use of NSAIDs in the preceding 4 months were excluded from the trial.

Out of the 331,189 patients without known HF included in the study, 23,308 patients developed incident HF during follow-up. Sixteen percent of patients had a minimum of one prescription for NSAIDs within one year of their enrolment and 3% had three prescriptions. After adjustment for sex, age groups, atrial fibrillation, ischemic heart disease, chronic kidney disease, ischemic stroke, hypertension, chronic obstructive pulmonary disease, and cancer, the risk of hospitalization for new-onset heart failure was increased with the use of NSAIDS for a short period of time with odds ratio (OR) of 1.43. On subgroup analysis, the association was more pronounced in the elderly (≥80 years) with OR of 1.78, patients being treated with 0 to 1 antidiabetic drug with raised HbA1c levels (6.5%) with OR of 1.68. However, no such association was seen in patients with well-controlled diabetes. The risk increased 2-folds among participants who had not used NSAIDs earlier with OR of 2.71.

Examination of individual NSAIDs showed that the risk of heart failure hospitalisation was increased following the use of diclofenac or ibuprofen, with ORs of 1.48 and 1.46, respectively. No such risk was observed for celecoxib and naproxen, which the authors attribute may be due to the fewer prescriptions.

This study demonstrates a link between short-term use of NSAIDs and new-onset heart failure in patients with type 2 diabetes. The strongest association was seen among new users of NSAIDs or those who used them infrequently. Even though this is an observational study, physicians should be aware of this potential association and exercise due caution when prescribing NSAIDs for patients with type 2 diabetes, especially those in the high-risk groups as defined in this study.

Reference

1. Anders Holt, et al. Heart failure following anti-inflammatory medications in patients with type 2 diabetes mellitus. J Am Coll Cardiol. 2023 Apr.;81(15):1459–1470.