More Evidence of Cardiovascular Harm With NSAIDs

Volume 26, Issue 2

I’ll never forget this one trip I took to Europe. I had accidentally left my ibuprofen at home, and I needed to go to a pharmacy to find some. After spending some time scouring the aisles, I could not find any nonsteroidal anti-inflammatory drugs (NSAIDs) available for purchase. 

Eventually, I approached the counter and asked for help. The person behind the counter (not sure if she was a pharmacist or not) looked at me like I had three heads when I asked for ibuprofen. After a barrage of questions, she brought me to the back of the pharmacy, where the ibuprofen was kept locked in a drawer. She sold me exactly 8 pills and profusely cautioned me on the hazards of consuming even 1 dose. 

Anyone who has walked into a pharmacy in the United States knows ibuprofen can be purchased in jugs of 500 to 1000 tablets. This is despite the fact that there are well-described cardiovascular and renal hazards associated with chronic NSAID use. Indeed, NSAID use continues to be a leading cause of end-stage renal disease in this country. 

In this week’s issue of Talking Therapeutics, we explore a new study which further highlights the potential harms associated with NSAID use. 

Point 1: NSAIDs Potentially Harmful to Patients With Diabetes

In this new study, which was published in the Journal of the American College of Cardiology this week, investigators used a Danish registry of patients with an established diagnosis of type 2 diabetes but without incident heart failure. Using a case-crossover design, the researchers studied associations between NSAIDs and first-time hospitalizations for heart failure with exposure windows of 28 days.

These investigators found short-term use of NSAIDs was associated with increased risk of heart failure hospitalization (OR: 1.43; 95% CI: 1.27 to 1.63). This hazard was most pronounced in older adults aged 80 years or more (OR: 1.78; 95% CI: 1.39 to 2.28), those with elevated hemoglobin (Hb) A1c levels treated with 0 or 1 antidiabetic drugs (OR: 1.68; 95% CI: 1.00 to 2.88), and those who had not used NSAIDs previously (OR: 2.71; 95% CI: 1.78 to 4.23).

Point 2: List of NSAID Contraindications Is Growing

Many patients are not good candidates for NSAID therapy, including those with hypertension, heart failure, kidney disease, or a history of gastrointestinal bleeding. The results of this study suggest patients with type 2 diabetes should also be added to that list, particularly if they fall into one of the higher risk subgroups listed above. At the very least, practicing pharmacists should be aware of the results of this study and advise patients accordingly on the potential hazards associated with short-term NSAID use.