title: Risk of congestive heart failure with nonsteroidal antiinflammatory drugs and selective Cyclooxygenase 2 inhibitors: a class effect?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Using administrative databases, we performed a nested case-control study in a population-based cohort of patients ages >or=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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. marie.hudson@mcgill.ca
authors: Marie
authors: M
authors: Hudson
authors: Elham
authors: E
authors: Rahme
authors: Hugues
authors: H
authors: Richard
authors: Louise
authors: L
authors: Pilote
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000145:classification; D016022:Case-Control Studies; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects* / Q000145:classification; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects; D007783:Lactones / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010359:Patient Readmission; D011720:Pyrazoles / Q000009:adverse effects; D018570:Risk Assessment; D013449:Sulfonamides / Q000009:adverse effects; D013450:Sulfones / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D000068579:Celecoxib; D007213:Indomethacin