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Common Painkillers Linked With Heart Failure In People With Type 2 Diabetes

During a median follow-up of nearly six years, over 23,000 study subjects were hospitalized with heart failure for the primary time.



NSAID use was related to 40 percent higher relative risk of first-time heart failure hospitalization. When individual NSAIDs were analyzed individually, the danger of heart failure hospitalization was increased following the usage of diclofenac or ibuprofen, but not with celecoxib and naproxen, potentially because of the small percentage of individuals filling those prescriptions.

The researchers also looked prone to heart failure with NSAID use in subgroups of patients.

  • They found no association of NSAID use and increased risk in individuals with well-controlled diabetes.
  • Strong associations were present in people ages 65 and older, while no association was present in those younger than 65.
  • The strongest association was present in very infrequent or recent users of NSAIDs.

Data on over-the-counter use of NSAIDs weren’t included within the study.

Even Without Previous Heart Failure Diagnosis, NSAIDs May Be Dangerous for People With T2D

Although it is a single study, it was conducted in a really large group of patients using real world data, which makes these findings very compelling, says Salpy V. Pamboukian, MD, a cardiologist at UW Medicine in Seattle who makes a speciality of advanced heart failure and transplant. Dr. Pamboukian was not involved on this research.

“Cardiologists have long really helpful avoidance of NSAIDs in patients with a longtime diagnosis of heart failure, for fears of precipitating kidney failure or worsening heart failure. This study now extends these concerns to patients with type 2 diabetes without a previous heart failure diagnosis. This could be very significant,” she says.

NSAIDs are typically used to alleviate the pain of headaches, back pain, and arthritis. Essentially the most common drugs on this class are aspirin, ibuprofen (Motrin and Advil) and naproxen sodium (Aleve).

What Is the Connection Between NSAIDs and Heart Failure Risk?

In keeping with the Centers for Disease Control and Prevention (CDC), about 6.2 million U.S. adults have heart failure, which is when the center isn’t pumping as well appropriately. When an individual has heart failure, the cells within the body don’t get enough blood, which might cause fatigue and shortness of breath, based on the American Heart Association (AHA).

Previous research published within the BMJ found that in the overall population, current use (throughout the last two weeks) of any NSAID was related to a 19 percent increase of risk of hospital admission for heart failure compared with individuals who had not used NSAIDS for no less than six months. The upper the NSAID dose the person was taking, the greater the danger.

Given the upper risk of heart failure for individuals with type 2 diabetes, NSAIDs could possibly be much more detrimental on this at-risk group, based on the authors.

Findings Highlight the Risk of Common Pain Medications

NSAIDS are available and utilized by many patients to treat quite a lot of ailments, a lot of which they could never discuss with a health care provider about, says Pamboukian.

“These findings highlight the necessity for education in patients with cardiac risk aspects, akin to diabetes, on the risks that over-the-counter medications may pose. Patients assume medications that might be purchased and not using a prescription are ‘secure,’ but as this study shows, even commonly used medications can pose risk, even when used for a brief time frame,” she says.

Any patient who takes chronic medication needs to know that any recent drug they use can have interactions or opposed effects, and in the event that they aren’t sure in regards to the safety of a medicine (even a commonly used one) they need to check with their medical provider, says Pamboukian.

Age, A1c Control, and Medications May Place Some People at Very High Risk

It could be premature to make clinical recommendations solely based on these findings, which show an association but don’t prove that the NSAIDs caused the increased risk, says Holt.

“Nevertheless, the subgroup analyses provide some interesting insight. In practice, it could look as if older patients, NSAID naive patients, patients with uncontrolled diabetes, and patients on each RASi (renin angiotensin system inhibitor) and diuretics seem like more liable to the proposed association. Quite the opposite, no significant associations were present in younger patients, and in patients with well-controlled diabetes,” he says.

If NSAID treatment is well indicated and needed, the “high-risk” subgroups might profit probably the most from closer follow-up, reduced dosage, or other mitigation strategies, although the present data doesn’t support that practice — more research is required, says Holt.

Should People With T2D Avoid Taking NSAIDs?

Pamboukian recommends that individuals with diabetes, in addition to other cardiovascular conditions akin to hypertension (especially in the event that they are taking other cardiac medications), avoid NSAIDs altogether.

The “triple whammy” — of taking NSAIDs, diuretics, and ACE inhibitors or ARBs — places patients at a really high risk of heart and kidney failure, she says. “Other analgesics might be used and nonpharmacologic therapies to treat pain might be explored as alternatives to NSAIDS. I tell my patients that life is all about ‘risk versus profit’ — so long as they’re informed, it’s ultimately as much as them to make your mind up if the advantages of NSAIDs are definitely worth the risks,” says Pamboukian.

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