Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in patients with a history of cardiovascular disease. This is the conclusion of Dr John Page and Dr David Henry (faculty of medicine and health sciences, University of Newcastle, Australia) who have examined the relationship between the consumption of NSAIDs and the development of congestive heart failure (CHF) in elderly patients (Archives of Internal Medicine 2000;160:777).
The authors explain that in people with impaired ventricular function, NSAIDs can exacerbate the tendency for CHF to develop by raising systemic vascular resistance and reducing renal perfusion.
In the study, 365 cases (patients admitted to hospital with CHF) were compared with 658 controls (patients without CHF admitted to hospital on the same day as the case patient).
Recent use of NSAIDs by elderly patients was found to double the odds of being admitted to hospital with an episode of CHF. The risk of first admission for CHF was substantially increased by NSAID use in patients with a history of heart disease. In these patients, the risk of CHF was increased further by the use of NSAIDs at high dose or use of a drug with a long half-life.
The authors comment that use of NSAIDs should be discouraged in patients with a damaged but compensated left ventricle. In such patients, the lowest possible dose should be used and NSAIDs with long half-lives avoided.
The authors conclude that NSAIDs could have been responsible for 19 per cent of hospital admissions with CHF. A modest increase in the risk of CHF in users of these drugs could result in a substantial increase in morbidity and mortality, they say.