title: Non-steroidal anti-inflammatory drugs and risk of heart failure exacerbation: A systematic review and meta-analysis.
abstract: BACKGROUND
  The association between exacerbation of heart failure (HF) and use of non-steroidal anti-inflammatory drugs (NSAIDs) has long been recognized but the data on this adverse effect are limited.
  
  
  METHODS
  To further characterize this possible association, we conducted a systematic review and meta-analysis of observation studies that reported odds ratio, relative risk, hazard ratio or standardized incidence ratio comparing risk of exacerbation of HF in patients with pre-existing HF who took NSAIDs versus non-users. Pooled risk ratios (RR) and 95% confidence intervals for conventional NSAIDs, celecoxib and rofecoxib were calculated using random-effect, generic inverse variance method.
  
  
  RESULTS
  Six studies were identified and included in our data analysis. Use of conventional NSAIDs was associated with a significantly higher risk of development of exacerbation of HF with the pooled RR of 1.39 (95% CI 1.20-1.62). Elevated risk was also observed among celecoxib and rofecoxib users (RR 1.34, 95% CI 0.98-1.85 and RR 2.04, 95% CI 1.68-2.48). The pooled RR of rofecoxib was significantly higher than conventional NSAIDs (p=0.02).
  
  
  CONCLUSIONS
  Use of NSAIDs is associated with an increased risk of HF exacerbation among patients with pre-existing HF. The excess risk was approximately 40% for conventional NSAIDs and celecoxib. The highest risk was observed among rofecoxib users.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: Ungprasert.Patompong@mayo.edu.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Division of Critical Care and Pulmonary Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Narat
authors.initials: N
authors.lastname: Srivali
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Wonngarm
authors.initials: W
authors.lastname: Kittanamongkolchai
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000068579:Celecoxib / Q000009:adverse effects*; D018450:Disease Progression; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007783:Lactones / Q000009:adverse effects*; D016017:Odds Ratio; D017594:Publication Bias; D013450:Sulfones / Q000009:adverse effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D000068579:Celecoxib
keywords: Heart failure; Meta-analysis; Non-steroidal anti-Inflammatory drugs