This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (165)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in this journal

An Underrecognized Public Health Problem

John Page, MBBS(Hons); David Henry, MBChB

Arch Intern Med. 2000;160:777-784.

Background  Experimental studies have shown that administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to susceptible individuals can lead to the development of congestive heart failure (CHF). There have been few epidemiological investigations of the importance of this adverse effect.

Objective  To estimate the relative risk of first admission to a hospital with CHF in recent users of NSAIDs, compared 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 conducted a matched case-control study of the relationship between recent use of NSAIDs and hospitalization with CHF. Cases (n = 365) were patients admitted to hospitals with a primary diagnosis of CHF. Controls (n = 658) were patients without CHF who were admitted to the same hospitals as case patients. Structured interviews were used to obtain information on several study factors, including recent use of aspirin and other NSAIDs.

Results  Use of NSAIDs (other than low-dose aspirin) in the previous week was 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 ratio of 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 without such a history. The odds of a first admission to a hospital with CHF was positively related to the dose of NSAID consumed in the previous week, and was increased to a greater extent with long half-life than with short half-life drugs. Assuming these relationships are causal, NSAIDs were responsible for approximately 19% of hospital admissions with CHF.

Conclusions  The burden of illness resulting from NSAID-related CHF may exceed that resulting from gastrointestinal tract damage. NSAIDs should be used with caution in patients with a history of cardiovascular disease.

From the Centre for Clinical Epidemiology and Biostatistics (Dr Page) and Discipline of Clinical Pharmacology (Dr Henry), Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, Australia.

RELATED LETTER

NSAIDs, Intestinal Cell Integrity, and Bacterial Translocation in Chronic Heart Failure
Mathias Rauchhaus, Rakesh Sharma, and Aidan Bolger
Arch Intern Med. 2000;160(19):3004-3005.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(6):873-874.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT | FULL TEXT  

Review: Adverse cardiovascular effects of NSAIDs: driven by blood pressure, or edema?
Aneja and Farkouh
Therapeutic Advances in Cardiovascular Disease 2008;2:53-66.
ABSTRACT  

Adverse effects of spinal manipulation: a systematic review
Ernst
JRSM 2007;100:330-338.
ABSTRACT | FULL TEXT  

Coxibs and Heart Disease: What We Have Learned and What Else We Need to Know
Zarraga and Schwarz
J Am Coll Cardiol 2007;49:1-14.
ABSTRACT | FULL TEXT  

Non-steroidal anti-inflammatory drugs and risk of first hospital admission for heart failure in the general population
Huerta et al.
Heart 2006;92:1610-1615.
ABSTRACT | FULL TEXT  

Understanding the NSAID related risk of vascular events.
Vonkeman et al.
BMJ 2006;332:895-898.
FULL TEXT  

Can Natriuretic Peptide Levels Predict the Cardiovascular Complications of COX-2 Inhibitors and Nonsteroidal Anti-inflammatory Drugs?
Blankfield
J Am Board Fam Med 2006;19:178-182.
ABSTRACT | FULL TEXT  

Aspirin Use in Chronic Heart Failure: What Should We Recommend to the Practitioner?
Massie
J Am Coll Cardiol 2005;46:963-966.
ABSTRACT | FULL TEXT  

Obstructive sleep apnea: Diagnosis, medical management and dental implications
MAGLIOCCA and HELMAN
Journal of the American Dental Association 2005;136:1121-1129.
ABSTRACT | FULL TEXT  

Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease
Wei et al.
ANN INTERN MED 2004;141:764-770.
ABSTRACT | FULL TEXT  

Balancing benefits and harms: the example of non-steroidal anti-inflammatory drugs
Dieppe et al.
BMJ 2004;329:31-34.
FULL TEXT  

Palliative Care for Patients With Heart Failure
Pantilat and Steimle
JAMA 2004;291:2476-2482.
ABSTRACT | FULL TEXT  

Keeping Your Patient With Heart Failure Safe: A Review of Potentially Dangerous Medications
Amabile and Spencer
Arch Intern Med 2004;164:709-720.
FULL TEXT  

Both Thrombotic and Nonthrombotic Cardiovascular and Cerebrovascular Side Effects of Nonsteroidal Anti-Inflammatory Drugs Should Be Considered
Stollberger and Finsterer
Stroke 2004;35 :e26-e26.
FULL TEXT  

Gastrointestinal safety of AZD3582, a cyclooxygenase inhibiting nitric oxide donator: proof of concept study in humans
Hawkey et al.
Gut 2003;52:1537-1542.
ABSTRACT | FULL TEXT  

Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention
Podichetty et al.
Postgrad. Med. J. 2003;79:627-633.
ABSTRACT | FULL TEXT  

Using Bayes' nomogram to help interpret odds ratios
Page and Attia
Evid. Based Med. 2003;8:132-134.
FULL TEXT  

Interaction between cyclooxygenase and the renin-angiotensin-aldosterone system: rationale and clinical relevance
Meune et al.
Journal of Renin-Angiotensin-Aldosterone System 2003;4:149-154.
ABSTRACT  

Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery
Ott et al.
J. Thorac. Cardiovasc. Surg. 2003;125:1481-1492.
ABSTRACT | FULL TEXT  

Heart Failure
Jessup and Brozena
NEJM 2003;348:2007-2018.
FULL TEXT  

Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors
Hawkey and Langman
Gut 2003;52:600-608.
ABSTRACT | FULL TEXT  

Key questions concerning paracetamol and NSAIDs for osteoarthritis
Courtney and Doherty
Ann Rheum Dis 2002;61:767-773.
FULL TEXT  

Cyclooxygenase inhibition: between the devil and the deep blue sea
Hawkey
Gut 2002;50:iii25-30.
ABSTRACT | FULL TEXT  

Association of Nonsteroidal Anti-inflammatory Drugs With First Occurrence of Heart Failure and With Relapsing Heart Failure: The Rotterdam Study
Feenstra et al.
Arch Intern Med 2002;162:265-270.
ABSTRACT | FULL TEXT  

Aspirin, like all other drugs, is a poison
Tramèr
BMJ 2000;321:1170-1171.
FULL TEXT  

NSAIDs, Intestinal Cell Integrity, and Bacterial Translocation in Chronic Heart Failure
Rauchhaus et al.
Arch Intern Med 2000;160:3004-3005.
FULL TEXT  

Heart Failure Hospitalizations Associated with Recent NSAID Use
Journal Watch Cardiology 2000;2000:7-7.
FULL TEXT