Some nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of hospital admission for heart failure, according to data published in BMJ.

Giovanni Corrao, PhD, from the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milan, Italy, and colleagues sought to estimate the risk of hospital admission for heart failure with use of individual NSAIDs using data from 5 population-based healthcare databases from the Netherlands, Italy, Germany, and the United Kingdom.

The study included adults older than 18 years of age who began NSAID treatment between 2000 and 2010. The investigators identified 92,163 heart failure hospitalizations and 8,246,403 controls. They measured the association between the risk of hospitalization and the use of 27 individual NSAIDs, including 24 traditional NSAIDs and 4 COX 2 inhibitors. The researchers also analyzed the dose-response relationship between NSAID use and heart failure risk.

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The study authors found that current use of any NSAID within the preceding 14 days was associated with a 19% increased risk of hospital admission compared with prior history of NSAID use (adjusted odds ratio [OR], 1.19).

Risk of hospital admission was increased for 7 traditional NSAIDs, including diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam, and 2 COX inhibitors (etoricoxib and prioxicam).

The researchers noted that heart failure risk doubled at very high doses, defined as more than 2 daily doses, for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib. In addition, medium doses, defined as 0.9 to 1.2 daily dose equivalents, of indomethacin and etoricoxib increased heart failure risk. They did not observe an increased risk of heart failure with celecoxib at commonly used doses.

“Our findings support the hypothesis that selective and non-selective COX 2 inhibitors increase the risk of heart failure, but that the magnitude of this effect varies between individual drugs and according to the dose used,” the study authors noted. “The effect of individual NSAIDs could depend on a complex interaction of pharmacological properties, including duration and extent of platelet inhibition, extent of blood pressure increase, and properties possibly unique to the molecule.”


  1. Arfe A, Scotti L, Varas-Lorenzo C, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ. 2016; doi: 10.1136/bmj.i4857.