title: Nonsteroidal Anti-inflammatory Drugs and Risk of Incident Heart Failure: A Systematic Review and Meta-analysis of Observational Studies.
abstract: BACKGROUND
  The association between the development of heart failure (HF) and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established.
  
  
  OBJECTIVE
  Use of NSAIDs may increase the risk of incident HF.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of incident HF in NSAID users vs nonusers. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and both subclasses (conventional NSAIDs and highly selective cyclooxygenase-2 inhibitors [COXIBs]) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Seven studies with 7,543,805 participants were identified and included in our data analysis. Use of NSAIDs was associated with a significantly higher risk of developing HF, with a pooled RR of 1.17 (95% CI: 1.01-1.36). Subgroup analysis showed a significantly elevated risk among users of conventional NSAIDs (RR: 1.35, 95% CI: 1.15-1.57) but not users of COXIBs (RR: 1.03, 95% CI: 0.92-1.16).
  
  
  CONCLUSIONS
  A significantly elevated risk of incident HF was observed among users of NSAIDs.
authors.affiliation: Division of Rheumatology, Department of Medicine (Ungprasert), Mayo Clinic, Rochester, Minnesota.|Department of Medicine (Ungprasert), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Division of Critical Care and Pulmonary Medicine, Department of Medicine (Srivali, Mayo Clinic, Rochester, Minnesota.
authors.forename: Narat
authors.initials: N
authors.lastname: Srivali
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine (Thongprayoon), Mayo Clinic, Rochester, Minnesota.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016009:Chi-Square Distribution; D006333:Heart Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D064887:Observational Studies as Topic; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal