A study has showed that type 2 diabetes sufferers are more than twice as likely to develop heart failure if they take ibuprofen, particularly those over 65, and additionally, the risk of hospitalisation among those taking the drugs infrequently or for the first time was significantly higher.
Diabetes UK says the condition affects one in 10 Britons over 40, who are more likely to experience pain than non-sufferers, and may therefore be inclined to take painkillers more frequently, reports The Independent.
Over time, high blood sugar levels can damage the small blood vessels supplying the nerves in your body. This stops essential nutrients from reaching the nerves, which can lead to various forms of discomfort, from tingling and numbness, to burning and shooting pains.
Though previous studies have linked use of the anti-inflammartory drug to heart failure among the general population, there is relatively little information on how the painkiller affects people with pre-existing conditions.
The Copenhagen University study found that over-65 type 2 diabetes patients who took ibuprofen had a far higher risk of heart failure than younger people and even more at risk of hospitalisation if they were taking it occasionally or for the first time.
The researchers observed 300 000 patients with type 2 diabetes for nearly six years. Of that group, 50 000 took anti-inflammatory drugs – ibuprofen being one. Half of those who took the painkillers were hospitalised with heart failure for the first time, the team said.
Lead author of the study Dr Anders Holt of Copenhagen University Hospital, Denmark, said the results suggest that “increased risk of heart failure should be taken into account when considering the use of these medications”.
“On the contrary, the data indicates that it may be safe to prescribe short-term non-steroidal anti-inflammatory drugs (NSAIDs) for patients under 65 and those with well-controlled diabetes,” Holt said, adding that data on the over-the-counter use of ibuprofen were not included in the study.
Dr Faye Riley, research communications manager at Diabetes UK, said: “We know that NSAIDs, which are commonly used to treat pain and inflammation, are linked to heart complications.
“Living with type 2 diabetes can also increase the risk of developing heart problems. These findings emphasise the importance of careful consideration in prescribing NSAIDs to those who are already at a higher risk of heart problems, including people with type 2 diabetes.
“It’s important to note though, that for many, NSAIDs are safe to take.”
The findings, from the Danish registry study, were presented last week at the European Society of Cardiology (ESC) Congress (26-29 August).
Study details
Risk of heart failure following short-term non-steroidal anti-inflammatory drug use in patients with type 2 diabetes mellitus
A Holt, JE Strange, PV Rasmussen, P Blanche, N Nouhravesh, MH Jensen, AM Schjerning, M Schou, C Torp-Pedersen, GH Gislason, ML Hansen, P Mcgettigan, MK Lamberts.
Background
Fluid retention is a known but under-appreciated side-effect of non-steroidal anti-inflammatory drug (NSAID) use. As type 2 diabetes mellitus (T2DM) has been linked to both subclinical cardiomyopathy and a decline in kidney function, short-term NSAID use could lead to subsequently development of heart failure (HF) due to aberrations in fluid balances.
Purpose
We investigated associations between short-term NSAID use and the risk of HF in a nationwide cohort of patients with T2DM.
Methods
Using nationwide Danish registers, we identified patients diagnosed with T2DM during 1998–2018. Follow-up began 120 days after first-time T2DM diagnosis among patients without prior heart failure or a rheumatological diagnosis indicating long-term NSAID use.
To describe use of NSAID among patients with T2DM, we reported proportions of patients claiming at least 1, 2, 3 or 4 prescriptions of NSAID within one year of start of follow-up. We investigated associations between use of NSAIDs (celecoxib, diclofenac, ibuprofen and naproxen) and new-onset HF hospitalisations using a case-crossover design with 28-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI). The case-crossover design uses each individual as his or her own control making it suitable to study the effect of short-term exposure on immediate events while mitigating unmeasured confounding. Sensitivity analyses using exposure windows of 14 and 42 days were performed as well.
Results
A total of 334,950 patients with T2DM was included (47.7% female, median age of 61 [interquartile range 50–70]). Celecoxib and naproxen were rarely used; on the contrary, prescriptions of diclofenac and ibuprofen were claimed at least once within one year from the beginning of follow-up by 4.9% and 15.5% of patients, respectively—0.9% and 2.7% claimed at least four prescriptions (Figure 1).
The risk of new-onset HF hospitalisation was increased following use of diclofenac or ibuprofen with corresponding ORs of 1.3 (95% CI 1.0 to 1.7) and 1.3 (95% CI 1.1 to 1.5) using 28-day exposure windows. An increased risk following use of celecoxib or naproxen was not found (Figure 2).
Conclusion
NSAIDs diclofenac and ibuprofen were both widely used and associated with an increased risk of new-onset HF hospitalization in patients with T2DM. This suggests a previously unknown and serious, clinically relevant concern of NSAID use in patients with T2DM.
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