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NSAIDs linked to heart failure in elderly patients

NSAIDs are linked to an increased risk of heart failure in elderly patients, a major study has found.

The BMJ study looked at 10 million people, from the UK, Netherlands, Italy and Germany, with an average age of 77, who took non-steroid painkillers such as ibuprofen.

The researchers, from University of Milano-Bicocca in Italy, found that people taking any NSAID in the previous 14 days had a 19% increased risk of being taken to hospital with heart failure compared with others who had used NSAIDs at any point in the past.

The increased risk varied by dose and NSAID, from 16% for naproxen to 83% for ketorolac. They also found that COX-2 inhibitors increased the risk.

The authors said: ‘Because any potential increased risk could have a considerable impact on public health, the risk effect estimates provided by this study may help inform both clinical practices and regulatory activities.’

However, this was an observational study so cause and effect cannot be firmly established, and there is no information on absolute risks.

In addition the study focused on prescription NSAIDs, and the authors admit that ‘over-the-counter NSAIDs are probably typically used at lower doses, by younger people and for shorter durations than prescribed NSAIDs’.

Professor Peter Weissberg, medical director at the British Heart Foundation, said: ‘This large observational study reinforces previous research showing that some NSAIDs, a group of drugs commonly taken by patients with joint problems, increase the risk of developing heart failure. It has been known for some years now that such drugs need to be used with caution in patients with, or at high risk of, heart disease. This applies mostly to those who take them on a daily basis rather than only occasionally.

‘Since heart and joint problems often coexist, particularly in the elderly, this study serves as a reminder to doctors to consider carefully how they prescribe NSAIDs, and to patients that they should only take the lowest effective dose for the shortest possible time.’


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