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Heart Failure Following NSAID Use in Patients With Type 2 Diabetes Mellitus
TAKE-HOME MESSAGE
- The study investigated the risk of heart failure (HF) following short-term use of NSAIDs in patients with type 2 diabetes mellitus (T2DM) using data from nationwide Danish registers. The use of NSAIDs was associated with an increased risk of first-time HF hospitalization in patients with T2DM (OR, 1.43). The association was most notable in patients aged ≥80 years, in those with elevated HbA1c levels, and in those without previous NSAID use.
- These findings suggest that healthcare providers should carefully consider the risks and benefits of prescribing NSAIDs in patients with T2DM, especially in those who are at a high risk of developing HF.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Fluid retention and endothelial dysfunction have been related to use of nonsteroidal anti-inflammatory drugs (NSAIDs), and type 2 diabetes mellitus (T2DM) has been linked to both a decline in kidney function and subclinical cardiomyopathy.
OBJECTIVES
The authors hypothesized that short-term use of NSAIDs could lead to subsequent development of incident heart failure (HF) in patients with T2DM.
METHODS
Using nationwide Danish registers, we identified patients diagnosed with T2DM during 1998 to 2021 and included patients without previous HF, rheumatic disease, or use of NSAIDs 120 days before diagnosis. Associations between NSAIDs and first-time HF hospitalization were investigated using a case-crossover design with 28-day exposure windows, and ORs with 95% CIs were reported.
RESULTS
Included were 331,189 patients with T2DM: 44.2% female, median age of 62 years (IQR: 52-71 years); 23,308 patients were hospitalized with HF during follow-up, and 16% of patients claimed at least 1 NSAID prescription within 1 year. Short-term use of NSAIDs was associated with increased risk of HF hospitalization (OR: 1.43; 95% CI: 1.27-1.63), most notably in subgroups with age ≥80 years (OR: 1.78; 95% CI: 1.39-2.28), elevated hemoglobin (Hb) A1c levels treated with 0 to 1 antidiabetic drug (OR: 1.68; 95% CI: 1.00-2.88), and without previous use of NSAIDs (OR: 2.71; 95% CI: 1.78-4.23).
CONCLUSIONS
NSAIDs were widely used and were associated with an increased risk of first-time HF hospitalization in patients with T2DM. Patients with advanced age, elevated HbA1c levels, and new users of NSAID seemed more susceptible. These findings could guide physicians prescribing NSAIDs.
Additional Info
Disclosure statements are available on the authors' profiles:
Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus
J Am Coll Cardiol 2023 Apr 18;81(15)1459-1470, A Holt, JE Strange, N Nouhravesh, SK Nielsen, ME Malik, AM Schjerning, L Køber, C Torp-Pedersen, GH Gislason, P McGettigan, M Schou, M LambertsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patients with type 2 diabetes mellitus (T2DM) are at risk for developing heart failure (HF) and kidney dysfunction. In addition, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can result in kidney dysfunction, fluid retention, and increased risk of HF. The 2022 AHA/ACC/HFSA guideline for the management of HF1 recommends that NSAIDs be avoided or withdrawn whenever possible in patients with HF. However, the risk associated between NSAIDs and incident HF in patients with T2DM has not been established.
The present study assessed the risk of first-time HF hospitalization in patients with T2DM receiving NSAIDs. The study sample included patients from Danish nationwide health registers without prior HF or NSAID use within 120 days of the T2DM diagnosis. In a case–crossover design, the impact of NSAID use within 28 days of the first HF hospitalization was evaluated.
In this study, short-term NSAID use was associated with a 1.4-fold increased risk of HF hospitalization. This association was strongest in elderly patients (≥80 years), in patients with elevated glycosylated hemoglobin levels treated with at least one diabetes medication, in new users of NSAIDs, and in those with concomitant use of RAS inhibitors and diuretics. The association persisted even when considering shorter and longer windows of NSAID exposure as well as time since T2DM diagnosis.
The take-home message from this study is to employ caution when prescribing NSAIDs to patients with T2DM, especially those who are older with worse diabetic control or who are receiving RAS inhibitors and diuretics. For such patients, closer follow-up after NSAID initiation, with particular attention to fluid balance and kidney function, may mitigate the risk of subsequent HF hospitalization.
Reference