NSAIDs significantly increase the risk of heart failure in those living with type 2 diabetes

March 27, 2023

Summary: Those living with type 2 diabetes are at an increased risk of heart failure. The new study shows that even short-term use of NSAIDs like ibuprofen and diclofenac is associated with a significantly higher heart failure risk in those with type 2 diabetes. This risk is particularly seen in those older than 65 and living with poorly controlled diabetes. However, the risk is minimal in those with well-managed diabetes.

Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, diclofenac, naproxen, and celecoxib are among the most commonly used drugs. These medications help in chronic pain treatment and relief from inflammation as well as fever.These drugs are used for many acute and chronic health disorders. Thus, they might be used to manage seasonal flu, headaches, or chronic pains like those associated with arthritis. Hence, some people may use these drugs for a few days a year, and others might use them regularly for a long.

Though these medications are relatively safe, in recent years, doctors have raised concerns due to their extensive use. Moreover, some of these medications are even available as over-the-counter drugs.  In recent years researchers have found that these drugs may also cause some more severe health issues like increased risk of heart failure. 

Though there have been many high-quality studies in the general population showing that these medications might increase heart failure risk, it is unknown if they can also cause harm in those living with diabetes and diabetic neuropathy. Nonetheless, that is pretty much expected, as diabetes significantly increases the risk of cardiovascular disorders. Therefore, there is a need to understand the risk posed by NSAID use.

Understanding the harm of such medications in diabetes is vital, though it poses some challenges. Type 2 diabetes is quite common in the US, affecting about 10.5% of the population. Studies suggest that about one in six patients living with type 2 diabetes would use NSAIDs within one year. 

However, understanding whether short-term use of NSAIDs can increase the risk of heart failure in those living with diabetes is challenging since the risk of heart failure is twice higher in those living with diabetes.

In the new study, researchers used data from Danish registers. First, they identified all people diagnosed with diabetes between 1998 to 2021. They excluded those already living with rheumatological conditions or heart failure. Then they analyzed the prescription data for oral NSAIDs (ibuprofen, naproxen, diclofenac, and celecoxib). Then they looked at those who were hospitalized for heart failure for the first time. Thus, they were able to assess the risk of heart failure in those who used NSAIDs for the short term.

In the study, researchers included 331,189 patients living with type 2 diabetes with an average age of 62 years. Out of them, 16% reported using NSAIDs at least once a year, and 3% used them at least thrice. The most commonly used NSAIDs were ibuprofen and diclofenac, followed by naproxen and celecoxib. However, celecoxib use was relatively rare at 0.4% compared to 12.2% for ibuprofen.

The study found clear evidence that NSAIDs increased the risk of heart failure by 1.43 times, which is statistically significant. This risk was even higher for ibuprofen and diclofenac at 1.48 times. 

However, celecoxib and naproxen were not associated with increased heart failure risk. There could be two reasons for such findings. Firstly, these two drugs work differently than ibuprofen and diclofenac. Secondly, these drugs are prescribed less commonly. Interestingly, no association was found in those with normal HbA1C, indicating that well-controlled diabetes helps prevent NSAIDs side effects as well as assist in diabetic neuropathy treatment

Further, the study found that this association was only present in patients older than 65 years of age. So it means that the age of the patients also plays a role. Additionally, the study found that there was a higher risk for new and infrequent users – these findings are really interesting.Further, it is worth noting that this study only considered prescription NSAIDs and did not include data regarding their over-the-counter use. 

Researchers say this was just an observational study, but it shows a strong association between heart failure risk and NSAIDs use in those living with diabetes. The risk was exceptionally high in those older than 65 with poorly controlled diabetes.

By Gurpreet Singh Padda, MD, MBA, MHP