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Prescription painkillers linked to increased risk of heart failure

Commonly-used prescription drugs for treating pain and inflammation are associated with an increased risk of hospital admission for heart failure, says a team of international researchers. 

Commonly-used prescription drugs for treating pain and inflammation are associated with an increased risk of hospital admission for heart failure, says researchers. 

NSAIDS
Non-steroidal anti-inflammatory drugs are among those
potentially linked to an increased risk of heart failure. Picture: IStock

An international research team has found that drugs including traditional non-steroidal anti-inflammatory drugs (NSAIDs) and new generation anti-inflammatories, COX-2 inhibitors, raise the risk of heart failure. 

Previous studies have shown an association between the use of traditional NSAIDs and COX-2 inhibitors and an increased risk of heart failure, but the researchers said the relation between risk and dose response with individual drugs is still largely unknown.

To investigate this, they studied almost 10 million users of NSAIDs from four European countries – the Netherlands, Italy, Germany and the UK. 

A total of 27 individual NSAIDs, including 23 traditional NSAIDs and four selective COX-2 inhibitors, were included in the analysis. Overall, 92,163 hospital admissions for heart failure were identified and matched with 8,246,403 control patients. 

The researchers found that current use of any NSAIDs was associated with a raised risk of hospital admission for heart failure, compared with past use. 

Variable risk

After taking account of potentially influencing factors, risk of admission for heart failure increased for seven commonly used NSAIDs – diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide and piroxcam, and two COX-2 inhibitors – etoricoxib and rofecoxib. 

Risk varied between individual drugs and dose prescribed – at very high doses, risk of admission for heart failure doubled for some NSAIDs. 

‘Any potential increased risk could have a considerable impact on public health,’ the researchers said. ‘The risk effects estimates provided by this study may help inform both clinical practices and regulatory activities.’ 


Andrea Arfè A et al (2016) Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. The BMJ. doi: http://dx.doi.org/10.1136/bmj.i4857 

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