Results from a systematic review indicate a significantly increased risk of incident heart failure in patients who use non-steroidal anti-inflammatory drugs (NSAIDs). The study was published in Clinical Cardiology

The meta-analysis, conducted by Mayo Clinic researchers, included 7 studies with 7,543,805 patients that reported odds ratio, relative risk, hazard ratio, or standardized incident ratio comparing risk of incident heart failure in NSAID users vs. non-users. The research team calculated pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and subclasses (conventional NSAIDs and highly selective cyclooxygenase-2 inhibitors [COXIBs]) using a random-effect, generic inverse variance method.

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The review found that NSAIDs use was associated with a significantly higher risk of developing heart failure (pooled RR 1.17, 95% CI: 1.01–1.36). Analysis of the subclasses showed a significantly elevated risk for conventional NSAIDs users (RR 1.35, 95% CI: 1.15–1.57) but not for COXIBs users (RR 1.03, 95% CI: 0.92–1.16).

Researchers concluded that by combining all available data, the meta-analysis was able to prove statistical significance in the increased risk of heart failure among NSAID users. A possible explanation for the increased risk may be due to elevated blood pressure and fluid retention. As endothelium-derived prostaglandins exert a vasodilatory effect on the peripheral vasculature, inhibiting the COX enzyme could directly result in vasoconstriction and hypertension. Also, inhibition of the COX-2 enzyme by either conventional NSAIDs or COXIBs can lead to blood-volume expansion, which could lead to heart failure especially in patients who have existing ventricular dysfunction.

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