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Non-steroidal anti-inflammatory drugs and risk of heart failure exacerbation: A systematic review and meta-analysis

  • Patompong Ungprasert
    Correspondence
    Corresponding author at: Division of Rheumatology, Mayo Clinic, 200 1st street SW, Rochester, MN, USA, 55905.
    Affiliations
    Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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  • Narat Srivali
    Affiliations
    Division of Critical Care and Pulmonary Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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  • Wonngarm Kittanamongkolchai
    Affiliations
    Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Published:September 29, 2015DOI:https://doi.org/10.1016/j.ejim.2015.09.012

      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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