Heart Failure Observed in T2DM Patients Who Used NSAIDs

https://www.uspharmacist.com/article/heart-failure-observed-in-t2dm-patients-who-used-nsaids

Previous research has demonstrated that fluid retention and endothelial dysfunction have been correlated with the use of NSAIDs, and T2DM ( type 2 diabetes ) has been associated with both a deterioration in kidney function and sub-clinical cardiomyopathy. In a recent study, researchers indicated that the short-term use of NSAIDs among patients with T2DM is correlated with a higher risk for heart failure (HF) hospitalization.

In the study published in the Journal of the American College of Cardiology, researchers “hypothesized that short-term use of NSAIDs could lead to subsequent development of incident heart failure (HF) in patients with T2DM.”

The analysis included data from Danish nationwide health registers for patients aged 18 to 100 years who were diagnosed with T2DM or initiated anti-diabetic treatment from 1998 to 2021. Study participants had no previous HF or rheumatic disease or filled NSAID prescriptions 120 days before diagnosis. Type 1 diabetes patients and women aged younger than 40 years who were only taking metformin (who might represent polycystic ovary syndrome rather than T2D) were excluded.

Follow-up commenced 120 days after T2DM diagnosis, and the patients were followed until first-time HF hospitalization, death, or December 31, 2021, whichever occurred first.

The primary exposure was a claimed prescription for an NSAID, and the researchers reported percentages of patients who claimed up to four prescriptions within 1 year from the start of follow-up. In the case-crossover analyses, the participants were considered exposed if an NSAID prescription was claimed within 28 days before the initial HF hospitalization.

The results revealed that of the 333,189 patients with T2DM, 44.2% were female, the average age was 62 years (interquartile range: 52-71 years) with 23,308 patients being hospitalized with HF during follow-up, and 16% of patients indicated the use of at least one NSAID prescription within 1 year.

Additionally, short-term use of NSAIDs was correlated with augmented risk of HF hospitalization (odds ratio [OR] 1.43; 95% CI, 1.27-1.63), most notably in subgroups aged ≥80 years (OR 1.78; 95% CI, 1.39-2.28), elevated hemoglobin A1c (HbA1c) levels treated with zero to one anti-diabetic drug (OR 1.68; 95% CI, 1.00-2.88), and without previous use of NSAIDs (OR 2.71; 95% CI, 1.78-4.23).

All-cause mortality after the initial HF hospitalization was reduced in patients exposed to NSAIDs compared with those who were not exposed to use of NSAIDs before HF hospitalization, with a 1-year standardized absolute risk difference (ARD) of –2.9% (95% CI, –5.3% to –0.4%), a 3-year ARD of –3.7% (95% CI, –6.9% to –0.5%), and a 5-year ARD of –3.9% (95% CI, –7.3% to –0.5%).

The authors concluded, “An elevated risk of HF was found when relating short-term NSAID use and first-time HF hospitalization using a self-controlled design with advanced age, elevated HbA1c levels, and no previous use of NSAIDs most strongly associated with first-time HF.”

Finally, the authors wrote. “Interestingly, the prognosis following incident HF for both NSAID-exposed and nonexposed was comparable. Individual risk assessment is advised if prescribing NSAIDs for patients with T2DM.”

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Filed under: General Problems