Nonsteroidal Anti-Inflammatory Drugs and Risk of First Hospitalization for Heart Failure in Patients with No History of Heart Failure: A Population-Based Case-Crossover Study

Huang, Sung-Po; Wen, Yao-Chun; Huang, Shih‐Tsung; Lin, Chien‐Heng; Wang, Tzung‐Dau; Hsiao, Fei‐Yuan

doi:10.1007/s40264-018-0720-9

Cited by 18 publications

(15 citation statements)

References 34 publications

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“…The hazard and control periods were defined according to the exposure of interest as follows: Potassium: 30 days (to cover acute hypokalemia and account for possible potassium accumulation); NSAIDs: 30 days (in accordance with previous studies [6,8,9,11,33]); and amoxicillin/clavulanic acid: 15 days (to allow for treatment durations of usually 1-2 weeks depending on indication and severity). Shortened time periods were used as sensitivity analyses ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, even in the general population, recent NSAID use is associated with increased risk for heart failure hospitalization [6,7]. Huang et al [8] conducted a case-crossover study in the National Health Insurance Research Database in Taiwan, evaluating NSAID use in patients without a history of heart failure. They report a 1.58-fold increased risk for a first heart failure hospitalization (adjusted OR, 95% CI 1.40-1.79, hazard period 1-30 days, control period 121-150 days).…”

Section: Nsaidsmentioning

confidence: 99%

“…Previous studies also found a dose-dependent effect. In addition, varying risks between individual NSAIDs were reported [7,8,10,11].…”

Section: Nsaidsmentioning

confidence: 99%

“…Examples for common drug mechanisms that may favor HF deterioration comprise direct myocardial toxicity and negative inotropic or chronotropic effects, but drugs may also exacerbate hypertension, deliver high sodium loads, or cause drug-drug interactions that may limit the beneficial effects of (other) HF medications [4]. Several studies have assessed the association between prescriptions of non-steroidal anti-inflammatory drugs (NSAIDs) and HF hospitalization [6][7][8][9][10][11]. The hypothesized underlying mechanism is the inhibition of the prostaglandin synthesis, potentially resulting in reduced renal perfusion, glomerular filtration rate, and increased peripheral systemic resistance [7].…”

Section: Introductionmentioning

confidence: 99%

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Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Jödicke

Burden

Zellweger

et al. 2020

Eur J Clin Pharmacol

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Purpose Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. Methods Using Swiss claims data (2014-2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1-30 days before hospitalization vs. 31-60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. Results We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24-3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39-2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06-5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01-2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14-1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41-3.62, p = 0.001). Conclusion Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management.

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Section: Discussionmentioning

confidence: 99%

Section: Nsaidsmentioning

confidence: 99%

“…Previous studies also found a dose-dependent effect. In addition, varying risks between individual NSAIDs were reported [7,8,10,11].…”

Section: Nsaidsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Jödicke

Burden

Zellweger

et al. 2020

Eur J Clin Pharmacol

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“…Риск госпитализации по поводу декомпенсации сердечной недостаточности примерно удваивается как для коксибов, так и для ингибиторов ЦОГ-1 и ЦОГ-2 и всех «обычных» НПВП (табл. 2) [20,[29][30][31].…”

Section: Nsaids' Adverse Events and Their Reduction нежелательные реаunclassified

Adverse Reactions of the Cardiovascular System when Taking Nonsteroidal Anti-inflammatory Drugs and Ways to Reduce Them

Пырикова

Антропова

Осипова

2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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The most important issue of modern pharmacotherapy is not only efficacy, but also the safety of medicines. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the main methods of treating acute and chronic pain in a wide range of diseases and pathological conditions. However, the prescription of this group of drugs requires consideration of the potential risks of complications, including from the side of the cardiovascular system. The purpose of the review was to assess the adverse reactions of the cardiovascular system when taking NSAIDs and approaches to their reduction. The article presents data on the mutual potential impact of cardiovascular diseases and musculoskeletal system, presents the results of large-scale studies of Russian and foreign authors and meta-analyzes of the NSAIDs effect on blood pressure profile, development of myocardial infarction, stroke and heart failure. The possible pathogenetic mechanisms of the side effects of NSAIDs are reviewed; the complexity of managing comorbid patients is demonstrated; it is shown that symptomatic treatment of pain and inflammatory syndrome should be carried out considering a personalized approach to the patient and rational choice of drugs.Before the NSAIDs prescription, it is necessary to consider all cardiovascular risk factors with the determination of the total risk of cardiovascular complications. In patients with a very high cardiovascular risk, the use of any NSAIDs should be avoided; with high and moderate risk, the use of NSAIDs with the most favorable cardiovascular safety profile is possible. If the patient belongs to the category of low total coronary risk, the doctor can choose any NSAIDs.

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Comparative Risks of Nonsteroidal Anti‐inflammatory Drugs on Cardiovascular Diseases: A Population‐Based Cohort Study

Wan

Chan

et al. 2022

The Journal of Clinical Pharma

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Through examining the incidence of cardiovascular diseases (CVDs) among nonsteroidal anti-inflammatory drug (NSAID) users and nonusers, this study aims to compare the risks contributed by different NSAIDs in a Chinese population. The retrospective cohort including 4 298 368 adults without CVD from electronic health records between 2008 and 2017 in Hong Kong was adopted. A total of 4.5% of individuals received NSAIDs including celecoxib, etoricoxib, diclofenac, ibuprofen, indomethacin, mefenamic acid, or naproxen for ≥4 consecutive weeks at baseline. Cox regression, including NSAID use as a time-dependent covariate and adjusted with patient's characteristics, was conducted to examine the association between NSAID exposure and incident CVD. After a median follow-up of 6.9 years (30 million person-years), a total of 258 601 cases of incident CVD was recorded. NSAID use was shown to be associated with a significantly higher risk of CVD (hazard ratio [HR], 1.32 [95%CI, 1.28-1.37]) compared to non-NSAID use. Similar results in coronary heart disease (HR, 1.37 [95%CI,), stroke (HR, 1.27 [95%CI,), and heart failure (HR, 1.25 [95%CI,) were obtained. Overall, similar CVD risk was observed across users of NSAIDs except for etoricoxib, which showed a higher risk (HR, 2.01 [95%CI, 1.63-2.48]). Considering that a higher CVD risk was consistently displayed among NSAID users, NSAIDs should be used cautiously, and the usage of etoricoxib in the Chinese population should be reviewed.

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Nonsteroidal Anti-Inflammatory Drugs and Risk of First Hospitalization for Heart Failure in Patients with No History of Heart Failure: A Population-Based Case-Crossover Study

Abstract: Both traditional NSAIDs and COX-2 inhibitors were associated with an increased risk of heart failure leading to hospitalization in patients without a related history of heart failure.

Cited by 18 publications

References 34 publications

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Adverse Reactions of the Cardiovascular System when Taking Nonsteroidal Anti-inflammatory Drugs and Ways to Reduce Them

Comparative Risks of Nonsteroidal Anti‐inflammatory Drugs on Cardiovascular Diseases: A Population‐Based Cohort Study

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