Common painkillers could send diabetics to the hospital with heart failure

BARCELONA, Spain — Even occasional use of non-steroidal anti-inflammatory drugs (NSAIDs) could send type 2 diabetes patients to the hospital with heart failure, a new study warns. Researchers in Denmark found that medications like ibuprofen and naproxen increase the risk of heart problems, especially among older diabetics.

“In our study, approximately one in six patients with type 2 diabetes claimed at least one NSAID prescription within one year,” notes first author Dr. Anders Holt of Copenhagen University Hospital in a media release. “In general, we always recommend that patients consult their doctor before starting a new medication, and with results from this study we hope to help doctors mitigate risk if prescribing NSAIDs.”

Researchers note that previous studies have linked NSAID use to heart failure among the general population, but there’s been less information on how these common painkillers affect people with pre-existing conditions, including diabetes. They add that people with type 2 diabetes are already twice as likely to develop heart failure than those without diabetes. Therefore, taking painkillers like celecoxib, diclofenac, ibuprofen, and naproxen could be extremely dangerous.

Which drugs pose the greatest risk?

Study authors examined a nationwide sampling of Danish adults with type 2 diabetes, diagnosed between 1998 and 2021. The group had an average age of 62 and researchers excluded anyone with a history of heart failure or immune system-related conditions.

In total, the study included 331,189 patients with type 2 diabetes. During the first year, 16 percent reported using at least one NSAID prescription, while three percent used over three of these drugs.

Over 12 percent used ibuprofen, 3.3 percent used diclofenac, 0.9 percent used naproxen, and 0.4 percent used celecoxib. Over a follow-up period of nearly six years, 23,308 participants entered a hospital with heart failure for the first time in their lives.

Results show NSAID use elevated the risk of needing hospitalization for heart failure. Overall, diabetics using these common painkillers had an odds ratio (OR) of 1.43 — meaning they were nearly one and a half times more likely to need hospitalization for heart failure than people who avoided NSAIDs.

Individually, diclofenac use produced an odds ratio of 1.48 and ibuprofen produced a ratio of 1.46. Celecoxib and naproxen did not increase the risk of heart failure, but researchers caution that the small number of people taking those drugs may have distorted the results.

Regular painkiller users are safer than new users

The team also found that NSAID use among diabetes patients had a much stronger connection to heart failure for participants over 65. The study did not find the same risk among type 2 diabetes participants younger than 65. Additionally, the risk of hospitalization was actually higher among people taking these drugs infrequently or for the first time.

“This was an observational study and we cannot conclude that NSAIDs cause heart failure in patients with type 2 diabetes. However, the results suggest that a potential increased risk of heart failure should be taken into account when considering the use of these medications. On the contrary, the data indicate that it may be safe to prescribe short-term NSAIDs for patients below 65 years of age and those with well-controlled diabetes,” Dr. Holt concludes.

The team presented their findings at ESC Congress 2022.

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