Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study.
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.
Feenstra
Johan
J
Pharmacoepidemiology Unit, Department of Epidemiology & Biostatistics, Erasmus Medical Center Rotterdam, 3000 DR Rotterdam, The Netherlands.
Heerdink
Eibert R
ER
Grobbee
Diederick E
DE
Stricker
Bruno H Ch
BH
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D015984:Causality; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal