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Non‐steroidal anti‐inflammatory drugs and cardiac failure: meta‐analyses of observational studies and randomised controlled trials
Author(s) -
Scott Paul A,
Kingsley Gabrielle H.,
Scott David L
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.07.013
Subject(s) - medicine , heart failure , observational study , rofecoxib , placebo , meta analysis , odds ratio , relative risk , randomized controlled trial , confidence interval , pathology , biochemistry , chemistry , alternative medicine , cyclooxygenase , enzyme
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.