TY - JOUR
T1 - Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study
AU - Arfe, A.
AU - Scotti, L.
AU - Varas-Lorenzo, C.
AU - Nicotra, F.
AU - Zambon, A.
AU - Kollhorst, B.
AU - Schink, T.
AU - Garbe, E.
AU - Herings, R.
AU - Straatman, H.
AU - Schade, R.
AU - Villa, M.
AU - Lucchi, S.
AU - Valkhoff, V.
AU - Romio, S.
AU - Thiessard, F.
AU - Schuemie, M.
AU - Pariente, A.
AU - Sturkenboom, M.
AU - Corrao, G.
AU - Safety of Non-steroidal Anti-inflammatory Drugs Project, Consortium
N1 - Arfe, Andrea Scotti, Lorenza Varas-Lorenzo, Cristina Nicotra, Federica Zambon, Antonella Kollhorst, Bianca Schink, Tania Garbe, Edeltraut Herings, Ron Straatman, Huub Schade, Rene Villa, Marco Lucchi, Silvia Valkhoff, Vera Romio, Silvana Thiessard, Frantz Schuemie, Martijn Pariente, Antoine Sturkenboom, Miriam Corrao, Giovanni (SOS) eng Research Support, Non-U.S. Gov't England BMJ. 2016 Sep 28;354:i4857. doi: 10.1136/bmj.i4857.
PY - 2016
Y1 - 2016
N2 - OBJECTIVES: To investigate the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) and estimate the risk of hospital admission for heart failure with use of individual NSAIDs. DESIGN: Nested case-control study. SETTING: Five population based healthcare databases from four European countries (the Netherlands, Italy, Germany, and the United Kingdom). PARTICIPANTS: Adult individuals (age >/=18 years) who started NSAID treatment in 2000-10. Overall, 92 163 hospital admissions for heart failure were identified and matched with 8 246 403 controls (matched via risk set sampling according to age, sex, year of cohort entry). MAIN OUTCOME MEASURE: Association between risk of hospital admission for heart failure and use of 27 individual NSAIDs, including 23 traditional NSAIDs and four selective COX 2 inhibitors. Associations were assessed by multivariable conditional logistic regression models. The dose-response relation between NSAID use and heart failure risk was also assessed. RESULTS: Current use of any NSAID (use in preceding 14 days) was found to be associated with a 19% increase of risk of hospital admission for heart failure (adjusted odds ratio 1.19; 95% confidence interval 1.17 to 1.22), compared with past use of any NSAIDs (use >183 days in the past). Risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). Odds ratios ranged from 1.16 (95% confidence interval 1.07 to 1.27) for naproxen to 1.83 (1.66 to 2.02) for ketorolac. Risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses (>/=2 defined daily dose equivalents), although some confidence intervals were wide. Even medium doses (0.9-1.2 defined daily dose equivalents) of indomethacin and etoricoxib were associated with increased risk. There was no evidence that celecoxib increased the risk of admission for heart failure at commonly used doses. CONCLUSIONS: The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent. This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.
AB - OBJECTIVES: To investigate the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) and estimate the risk of hospital admission for heart failure with use of individual NSAIDs. DESIGN: Nested case-control study. SETTING: Five population based healthcare databases from four European countries (the Netherlands, Italy, Germany, and the United Kingdom). PARTICIPANTS: Adult individuals (age >/=18 years) who started NSAID treatment in 2000-10. Overall, 92 163 hospital admissions for heart failure were identified and matched with 8 246 403 controls (matched via risk set sampling according to age, sex, year of cohort entry). MAIN OUTCOME MEASURE: Association between risk of hospital admission for heart failure and use of 27 individual NSAIDs, including 23 traditional NSAIDs and four selective COX 2 inhibitors. Associations were assessed by multivariable conditional logistic regression models. The dose-response relation between NSAID use and heart failure risk was also assessed. RESULTS: Current use of any NSAID (use in preceding 14 days) was found to be associated with a 19% increase of risk of hospital admission for heart failure (adjusted odds ratio 1.19; 95% confidence interval 1.17 to 1.22), compared with past use of any NSAIDs (use >183 days in the past). Risk of admission for heart failure increased for seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib). Odds ratios ranged from 1.16 (95% confidence interval 1.07 to 1.27) for naproxen to 1.83 (1.66 to 2.02) for ketorolac. Risk of heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib used at very high doses (>/=2 defined daily dose equivalents), although some confidence intervals were wide. Even medium doses (0.9-1.2 defined daily dose equivalents) of indomethacin and etoricoxib were associated with increased risk. There was no evidence that celecoxib increased the risk of admission for heart failure at commonly used doses. CONCLUSIONS: The risk of hospital admission for heart failure associated with current use of NSAIDs appears to vary between individual NSAIDs, and this effect is dose dependent. This risk is associated with the use of a large number of individual NSAIDs reported by this study, which could help to inform both clinicians and health regulators.
KW - Aged Aged, 80 and over Anti-Inflammatory Agents, Non-Steroidal/adverse effects Case-Control Studies Databases, Factual Female Germany Heart Failure/chemically induced/epidemiology Hospitalization/statistics & numerical data Humans Italy Logistic Models Ma
U2 - https://doi.org/10.1136/bmj.i4857
DO - https://doi.org/10.1136/bmj.i4857
M3 - Article
SN - 1756-1833
VL - 354
SP - i4857
JO - BMJ
JF - BMJ
ER -