NSAID use ups risk of heart failure in T2DM patients

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) tends to elevate the risk of first-time hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2DM), a study has shown. In addition, those with advanced age, elevated haemoglobin (Hb) A1c levels, and new users are particularly at higher risk.

In this study, the authors assumed that short-term NSAID use could result in the development of incident HF in T2DM patients. To prove this, they used nationwide Danish registers and identified individuals diagnosed with T2DM from 1998 to 2021 and included those without previous HF, rheumatic disease, or use of NSAIDs 120 days prior to diagnosis.

The authors also examined the relationship between NSAIDs and first-time HF hospitalization using a case-crossover design with 28-day exposure windows.

A total of 331,189 patients with T2DM (median age 62 years, 44.2 percent female) were identified, of whom 23,308 were hospitalized with HF during follow-up. In addition, 16 percent of the patients claimed at least one NSAID prescription within a year.

Use of NSAIDs in the short term resulted in a higher likelihood of HF hospitalization (odds ratio [OR], 1.43, 95 percent confidence interval [CI], 1.27‒1.63), particularly in patients aged ≥80 years (OR, 1.78, 95 percent CI, 1.39‒2.28), who had elevated HbA1c levels treated with 0 to 1 antidiabetic drug (OR, 1.68, 95 percent CI, 1.00‒2.88), and without previous use of NSAIDs (OR, 2.71, 95 percent CI, 1.78‒4.23).

“These findings could guide physicians prescribing NSAIDs,” the authors said.

“Fluid retention and endothelial dysfunction have been related to use of NSAIDs, and T2DM has been linked to both a decline in kidney function and subclinical cardiomyopathy,” they noted.