© 2008 European Society of Cardiology
Non-steroidal anti-inflammatory drugs and cardiac failure: meta-analyses of observational studies and randomised controlled trials
a Department of Cardiology, Southampton University Hospital Southampton, SO16 6YD, UK
b Department of Rheumatology, Kings College London School of Medicine London SE5 9RS, UK
c Department of Rheumatology, University Hospital Lewisham London SE13 6LH, UK
d Department of Rheumatology, Kings College Hospital London SE5 9RS, UK
* Corresponding author. Department of Rheumatology, Kings College London School of Medicine, 10 Cutcombe Road, London SE5 9RS, UK. Tel.: +44 207 848 5215; fax: +44 207 848 5202. E-mail address: david.l.scott{at}kcl.ac.uk (D.L. Scott)
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Abstract |
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Aims: To determine the risks of cardiac failure with non-steroidal anti-inflammatory drugs (NSAIDs) and the specific risks with Cox-2 specific NSAIDs (COXIBs).
Methods: We performed meta-analyses examining the risks of developing cardiac failure in observational studies and in randomised controlled trials (RCTs) involving patients with arthritis and non-rheumatic disorders. Electronic databases and published bibliographies were systematically searched (1997–2008).
Results: Five case—control studies (4657 patients, 45,862 controls) showed a non-significant association between NSAIDs and cardiac failure in a random effect model (odds ratio (OR) 1.36; 95% CI 0.99–1.85). Two cohort studies (27,418 patient years, 55,367 control years) showed a significant risk of cardiac failure with NSAIDs (relative risk 1.97; 95% CI 1.73–2.25). Six placebo-controlled trials (naproxen, rofecoxib and celecoxib) in non-rheumatic diseases (15,750 patients) showed more cardiac failure with NSAIDs (Peto OR 2.31; 95% CI 1.34, 4.00). Six RCTs comparing conventional NSAIDs and COXIBs in arthritis (62,653 patients) showed no difference in cardiac failure risk (Peto OR 1.14; 95% CI 0.85–1.53).
Conclusion: Observational studies and RCTs all show that NSAIDs increase the risk of cardiac failure. Overall risks are relatively small and are similar with conventional NSAIDs and COXIBs. Pre-existing cardiac failure increases risk.
Key Words: NSAIDs • OXIBs • Adverse events • Cardiac failure • Meta-analysis
Received February 18, 2008; Revised May 27, 2008; Accepted July 15, 2008
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