Consumption of NSAIDs and the development of congestive heart failure in elderly patients - An underrecognized public health problem

Background: Experimental studies have shown that administration of nonstero idal anti-inflammatory drugs (NSAIDs) to susceptible individuals can lead t o the development of congestive heart failure (CHF). there have been few ep idemiological investigations of the importance of this adverse effect. Objective: To estimate the relative risk of first admission to a hospital w ith CHF in recent users of NSAIDs, compares with nonusers, and to determine whether the estimated relative risk was increased in those with a history of heart disease and the extent to which the level of risk varied with the dose and half-life of the drugs consumed. Methods: We consumed a matched case-control study of the relationship betwe en recent use of NSAIDs and hospitalization with CHF. Cases (n = 365) were patients admitted to hospitals with a primary diagnosis of CHF who were adm itted to the same hospitals as case patients. Structures interviews were us ed to obtain information on several factors, including recent use of aspiri n and other NSAIDs. Results: Use of NSAIDs (other than low-dose aspirin) in the previous week w as associated with a doubling of the odds of a hospital admission with CHF (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.3). Use of NSAIDs by patients with a history of heart disease was associated with an odds ra tio 10.5 (95% confidence interval, 2.5-44.9) for first admission with heart failure, compared with 1.6 (95% confidence interval, 0.7-3.7) in those wit hout such a history. The odds of a first admission to a hospital with CHF w as positively related tot he dose of NSAID consumed in the previous week, a nd was increased to a greater extent with long half-life than with short ha lf-life drugs. Assuming these relationships are casual, NSAIDs were respons ible for approximately 19% of hospital admissions with CHF. Conclusions: The burden of illness resulting from NSAID-related CHF may exc eed that resulting from gastrointestinal react damage. NSAIDs should be use d with caution in patients with a history of cardiovascular disease.