Dr. Rahme has received consulting fees (more than $10,000 each) from Merck, Pfizer, and Boehringer Ingelheim.
Risk of congestive heart failure with nonsteroidal antiinflammatory drugs and selective Cyclooxygenase 2 inhibitors: A class effect?
Article first published online: 29 MAR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 3, pages 516–523, 15 April 2007
How to Cite
Hudson, M., Rahme, E., Richard, H. and Pilote, L. (2007), Risk of congestive heart failure with nonsteroidal antiinflammatory drugs and selective Cyclooxygenase 2 inhibitors: A class effect?. Arthritis & Rheumatism, 57: 516–523. doi: 10.1002/art.22614
- Issue published online: 29 MAR 2007
- Article first published online: 29 MAR 2007
- Manuscript Accepted: 8 AUG 2006
- Manuscript Received: 15 FEB 2006
- Canadian Institutes of Health Research. Grant Number: 122882
- Canadian Institutes of Health Research
- Nonsteroidal antiinflammatory drugs;
- Cyclooxygenase 2 inhibitors;
- Congestive heart failure;
- Class effect
Nonsteroidal antiinflammatory drugs (NSAIDs) as a class have been shown to increase the risk of congestive heart failure (CHF) compared with celecoxib. The magnitude of the risk for individual NSAIDs is not known.
Using administrative databases, we performed a nested case–control study in a population-based cohort of patients ages ≥66 years admitted for CHF between January 1998 and March 2003. Cases were patients readmitted for CHF after cohort entry (index date). Four controls were matched to each case on date of cohort entry and time between cohort entry and index date. Exposure was the current use of an NSAID or a coxib in the 7 days prior to CHF readmission. Using conditional logistic regression, we calculated the odds of readmission for CHF in patients exposed to naproxen, diclofenac, ibuprofen, indomethacin, or rofecoxib compared with celecoxib, after adjusting for possible confounding variables.
We identified 8,512 cases and 34,048 controls. The baseline characteristics between the groups were similar in general. The odds of being readmitted for CHF were higher in patients currently exposed to indomethacin (odds ratio [OR] 2.04, 95% confidence interval [95% CI] 1.16–3.58) or rofecoxib (OR 1.58, 95% CI 1.19–2.11) compared with celecoxib. There was no difference between naproxen, diclofenac, and ibuprofen compared with celecoxib, although the numbers of exposed cases and controls were small.
In elderly patients with known CHF, indomethacin and rofecoxib are associated with a greater risk of recurrent CHF compared with celecoxib. Alternatives should be considered for patients with CHF who require antiinflammatory drugs.