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Association of Nonsteroidal Anti-inflammatory Drugs With First Occurrence of Heart Failure and With Relapsing Heart Failure
The Rotterdam Study
Johan Feenstra, MD, PhD;
Eibert R. Heerdink, PharmD, PhD;
Diederick E. Grobbee, MD, PhD;
Bruno H. Ch. Stricker, MB, PhD
Arch Intern Med. 2002;162:265-270.
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with
first hospitalization for congestive heart failure (CHF). It is likely, however,
that NSAIDs precipitate a relapse but are less likely to induce a first occurrence
of (incident) heart failure.
Methods A total of 7277 participants in the Rotterdam Study were followed up
from the interview date until the first of the following events: a diagnosis
of incident heart failure, death, removal, or end of the follow-up period.
Excluded from the study population were all participants with prevalent heart
failure at baseline. Exposure to NSAIDs and other medication was calculated
on the basis of automated data on filled drug prescriptions in the pharmacies
within the study area. In a second analysis, we followed up all participants
with incident heart failure until the first relapse or the end of follow-up.
Results Incident heart failure was encountered in 345 participants during follow-up.
Current use of NSAIDs was associated with a relative risk of incident heart
failure of 1.1 (95% confidence interval [CI], 0.7-1.7), after adjustment for
age, sex, and concomitant medication. In patients with prevalent heart failure
who filled at least 1 NSAID prescription since diagnosis of heart failure,
the univariate and adjusted relative risks of a relapse were 3.8 (95% CI,
1.1-12.7) and 9.9 (95% CI, 1.7-57.0), respectively.
Conclusions The use of NSAIDs is not associated with an increased risk of incident
heart failure. In patients with prevalent heart failure, current use of NSAIDs
is associated with a substantially increased risk of a relapse.
From the Pharmacoepidemiology Unit, Departments of Epidemiology &
Biostatistics and Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam
(Drs Feenstra and Stricker); Drug Safety Unit, Inspectorate for Health Care,
the Hague (Drs Feenstra and Stricker); Department of Pharmacoepidemiology
and Pharmacotherapy, University of Utrecht, Utrecht (Dr Heerdink); and Julius
Center for Patient Oriented Research, Academic Hospital Utrecht, Utrecht (Dr
Grobbee), the Netherlands.
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