Highlight
- •Use of NSAIDs is associated with a higher risk of heart failure exacerbation.
- •This excess risk is about 40% among conventional NSAID and celecoxib users.
- •The highest risk is observed among rofecoxib users.
Abstract
Background
The association between exacerbation of heart failure (HF) and use of non-steroidal
anti-inflammatory drugs (NSAIDs) has long been recognized but the data on this adverse
effect are limited.
Methods
To further characterize this possible association, we conducted a systematic review
and meta-analysis of observation studies that reported odds ratio, relative risk,
hazard ratio or standardized incidence ratio comparing risk of exacerbation of HF
in patients with pre-existing HF who took NSAIDs versus non-users. Pooled risk ratios
(RR) and 95% confidence intervals for conventional NSAIDs, celecoxib and rofecoxib
were calculated using random-effect, generic inverse variance method.
Results
Six studies were identified and included in our data analysis. Use of conventional
NSAIDs was associated with a significantly higher risk of development of exacerbation
of HF with the pooled RR of 1.39 (95% CI 1.20–1.62). Elevated risk was also observed
among celecoxib and rofecoxib users (RR 1.34, 95% CI 0.98–1.85 and RR 2.04, 95% CI
1.68–2.48). The pooled RR of rofecoxib was significantly higher than conventional
NSAIDs (p = 0.02).
Conclusion
Use of NSAIDs is associated with an increased risk of HF exacerbation among patients
with pre-existing HF. The excess risk was approximately 40% for conventional NSAIDs
and celecoxib. The highest risk was observed among rofecoxib users.
Keywords
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Article info
Publication history
Published online: September 29, 2015
Accepted:
September 18,
2015
Received in revised form:
September 9,
2015
Received:
August 13,
2015
Footnotes
☆Funding: None.
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
