Abstract 16285: Use of Non-steroidal Anti-inflammatory Drugs and Risk of First Hospitalization for Heart Failure in Diabetic Patients

Abstract

Introduction: Patients with diabetes mellitus are prone to have heart failure (HF), either as new onset or worsening. Non-steroidal anti-inflammatory drugs (NSAIDs) cause sodium, water retention and increase the risk of HF. Hypothesis: NSAIDs associated risk of HF in diabetic patients has not been well evaluated. Methods: Cohort study with a nested case-control analysis was done based on the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database. Among overall 78,453 diabetic patients, 1569 cases with first hospitalization for HF were identified and compared with 1:10 matched controls (n = 15,325). Current user of NSAIDs was defined as the most recent prescription lasted until the index date or ended in the 30 days before the index date. Results: In HF group, mean age was older and tended to have more previous HF, ischemic heart disease compared to control. Current NSAIDs user was much higher in HF group compared with control (534, 34 % vs 3,778, 25%, p < 0.001). The risk of a first hospital admission for HF associated with current use of NSAIDs was 1.60 (95% confidence interval (CI) 1.28 to 2.09) after controlling for major confounding factors. Multiple combination, high dose and injection of NSAIDs increased the risk of HF hospitalization (multiple combination; odds ratio (OR): 2.14, CI: 1.64 to 2.78, high dose; OR: 1.72, CI: 1.30 to 2.29, injection; OR: 2.36, CI: 1.79 to 3.09). NSAIDs associated risk of HF hospitalization was more significant, especially in diabetic patients with progressive diabetic retinopathy (OR: 2.23, CI 1.34 to 3.72) or overt neuropathy (OR: 4.59, CI: 2.84 to 7.43). Conclusions: Use of NSAIDs increased the risk of hospitalization for HF in diabetic patients, particularly with diabetic retinopathy and overt nephropathy as microvasculopathies. Therefore, the risk stratification for HF should be recommended in diabetic patients when the NSAIDs are prescribed.