NSAIDs May Elevate Risk of Heart Failure in Diabetic Patients

PainRelief.com: What are the main findings?

Response: In more than 330,000 patients with T2DM and without known HF, NSAID use was noticeable, with 16% claiming at least 1 prescription within a year. Relating short-term NSAID exposure to first-time HF hospitalization in a self-controlled design, an elevated risk was found following immediate NSAID exposure. The risk was greatest among older patients, patients with elevated HbA1c levels, and new users of NSAIDs. Five-year mortality risk following first-time HF was comparable for both exposed and nonexposed patients, suggesting that HF associated with use of NSAIDs could be more than temporary fluid overload.

PainRelief.com: What should readers take away from your report?

Response: Use of NSAIDs among patients with T2DM is common, and results from this study can aid physicians mitigate risk when prescribing NSAIDs for patients with T2DM. Advanced age, HbA1c levels, and being a new user were associated with the strongest associations, along with known use of RASis and diuretics. These findings could indicate patient groups in which improved vigilance and closer follow-up may be beneficial. 

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: Reproduction of these results as well as further investigations into the specific mechanisms causing these associations are warranted.

PainRelief.com: Is there anything else you would like to add? Any disclosures?

Response: It is wise to not base clinical practice solely on observational science; however, we believe that the subgroup analyses provide some interesting insight. In practice, it could look as if older patients, NSAID naïve patients, patients with uncontrolled diabetes, and patients on both RASi and diuretics (Triple Whammy 😊) already were more susceptible to the proposed association. On the contrary, no significant associations were found in younger patients, and in patients with well-controlled diabetes. If NSAID treatment is well-indicated and needed, the “high-risk” subgroups might be the ones benefitting most from closer follow-up, reduced dosage, or other mitigation strategies – although, we do not have data to support that

No relevant financial disclosures. Independent, external support for my research as indicated in the paper.


 Holt A, Strange J, Nouhravesh N, et al. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023 Apr, 81 (15) 1459–1470.https://doi.org/10.1016/j.jacc.2023.02.027

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