Based on real world data from four European countries and almost 10 million people using a full range of non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors (a new generation of NSAID commonly prescribed for arthritis pain).

The landmark analysis in the British Medical Journal found that NSAIDs raise risk of hospital admission for heart failure and that the magnitude of risk varied between individual NSAIDs and according to the dose prescribed.

Although not the first study to show such an association it is certainly one of the largest.

9 common drugs implicated

The 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). The increased risk of hospital admission ranged from 16% for naproxen to 83% for ketorolac.

Overall, the researchers found current NSAID users (defined as individuals who had used NSAIDs within the past 14 days) were 19% more likely to be admitted to the hospital with heart failure than past users (individuals who had not used NSAIDs for at least 183 days).

A particular of concern was that commonly used NSAIDS such as ibuprofen, diclofenac, and naproxen were all associated with increased risk of heart failure and that use of high doses of ibuprofen and diclofenac doubled the odds, though the increased risk associated with use of high dose naproxen was slightly lower.

By contrast with other selective COX-2 inhibitors (eg, rofecoxib, etirocoxib), celecoxib were not associated with increased risk of heart failure. But celecoxib was used mostly in low doses, so the safety of higher doses of celecoxib remains unexplored.

The researchers say that the new data “offers further evidence that the most frequently used individual traditional NSAIDs and selective COX 2 inhibitors are associated with an increased risk of hospital admission for heart failure. Moreover, the risk seems to vary between drugs and according to the dose.”

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