• Posted August 24, 2022

Certain Painkillers Raise Heart Failure Risk in People With Type 2 Diabetes

People with type 2 diabetes might face a substantially increased risk of heart failure if they take ibuprofen or some other type of nonsteroidal anti-inflammatory drug (NSAID), a new Danish study indicates.

Short-term NSAID use increased risk of hospitalization for heart failure by 43% among over 331,000 people in Denmark who had type 2 diabetes but no previous heart problems, according to research presented Tuesday at the European Society of Cardiology's annual meeting, in Barcelona. Such research is considered preliminary until published in a peer-reviewed journal.

NSAIDs increased the risk of heart failure even more in type 2 diabetics who were 80 or older (78%) or who had high blood sugar levels (68%), the results showed. Those who'd never used an NSAID before had the worst reaction, with their heart failure risk nearly tripling.

"Due to the very frequent use and the association found with even short-term NSAID use, we believe that some concern could be warranted," said lead researcher Dr. Anders Holt, a cardiologist with Copenhagen University Hospital in Denmark.

NSAIDs have previously been associated with a slightly increased risk of heart failure among the general population, and especially for people already suffering from heart problems, said Dr. Eugenia Gianos, director of Women's Heart Health at Lenox Hill Hospital in New York City.

"Certainly in patients who have heart failure already, those patients definitely have higher risk," said Gianos, a member of the American College of Cardiology's Prevention of Cardiovascular Disease Council.

Type 2 diabetes alone also increases risk of heart failure, possibly because elevated blood sugar impairs the muscle cells of the heart, Gianos explained.

"Even in the absence of blockages in the coronary arteries, or even without a decrease in the pumping function of their heart, they're still at risk for developing heart failure," Gianos said of type 2 diabetics.

To see whether NSAID use would further increase heart failure risk among diabetics, Holt and his team scoured Danish medical registries to identify people diagnosed with type 2 diabetes between 1998 and 2021.

They then excluded from the study those people who already had been diagnosed with heart failure, as well as those already on NSAIDs long-term due to a medical condition.

About 1 in 6 patients included in the study were prescribed at least one NSAID within a year of their type 2 diabetes diagnosis. Ibuprofen was the most commonly used, with 12% of diabetics picking up a prescription. The next most common was diclofenac, which was used by about 3% of patients.

Both of those NSAIDs were associated with an increased risk of hospitalization for heart failure among diabetics, the study showed.

However, heart failure was not associated with using NSAIDs in people with well-controlled diabetes and normal blood sugar levels.

NSAIDs mainly increase heart failure risk by causing fluid retention, Gianos said. This increases blood volume and places greater demands on the heart.

These medications also "have impact on the lining of the blood vessels, where they are known to increase blood pressure," said Dr. Gregg Fonarow, interim chief of cardiology at UCLA.

Type 2 diabetics should consult with their doctor before taking any pain medicine, the doctors said.

Other types of pain meds -- specifically acetaminophen (Tylenol) -- should be safe for them to use.

"Acetaminophen-containing drugs do not seem to have the associated heart failure risk," Fonarow said. "For pain relief, for fever reduction, acetaminophen would be preferred over the nonsteroidal anti-inflammatory agents."

More information

The Cleveland Clinic has more about NSAIDs.

SOURCES: Anders Holt, MD, cardiologist, Copenhagen University Hospital, Denmark; Eugenia Gianos, MD, director, Women's Heart Health, Lenox Hill Hospital, New York City; Gregg Fonarow, MD, interim chief, cardiology, UCLA; European Society of Cardiology, meeting, Barcelona, and news release, Aug. 23, 2022