Certain painkillers may raise heart failure risk, study finds

*Plant-based foods linked to reduced cardiovascular disease prevalence

A new study published in The BMJ has uncovered a dose-response relationship between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and increased risk of hospital admission for heart failure.

Also, a wealth of research has documented the link between the Mediterranean diet and better heart health. Providing further evidence of this association, a new study suggests the diet could reduce the risk of cardiovascular disease (CVD) and death.

Researchers have identified certain NSAIDs that may raise the risk of hospital admission for heart failure.NSAIDs are medications used to alleviate pain and reduce inflammation. They work by blocking the activity of COX-1 and COX-2 – enzymes that produce chemicals called prostaglandins, which promote inflammation.

According to the research team, led by Giovanni Corrao of the University of Milano-Bicocca in Italy, previous research has provided strong evidence that NSAIDs – including COX-2 inhibitors, a new generation of NSAIDs – can raise the risk of heart failure.

As such, clinical guidelines – such as those from the European Society of Cardiology – recommend limiting NSAID use among individuals who are already at increased risk of heart failure, while patients already diagnosed with heart failure should refrain from using NSAIDs completely.

“Nevertheless, thre is still limited information on the risk of heart failure associated with the use of individual NSAIDs (both COX-2 inhibitors and traditional NSAIDs) in clinical practice, and especially on their dose-response associations,” the authors note.

With this in mind, Corrao and team decided to estimate how the use and dose of individual NSAIDs affect the risk of hospital admission for heart failure.Nine NSAIDs linked to heart failure risk

The researchers assessed data from five population-based healthcare databases across four European countries: Germany, Italy, the Netherlands, and the United Kingdom.

More than 10 million NSAID users were included in the data, and these were matched with more than eight million controls.The analysis included a total of 27 NSAIDs, of which four were selective COX-2 inhibitors.

Overall, the researchers found current NSAID users (defined as individuals who had used NSAIDs within the past 14 days) were 19 percent more likely to be admitted to the hospital with heart failure than past users (individuals who had not used NSAIDs for at least 183 days).

After accounting for a number of possible confounding factors, the researchers identified seven widely used NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) that raised the risk of hospital admission for heart failure, as well as two COX-2 inhibitors (etoricoxib and rofecoxib).

What is more, the researchers identified a dose-response relationship; at very high doses, diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib were associated with double the risk of hospital admission for heart failure.Corrao and colleagues stress that their study is observational, so they are unable to confirm a causal link between NSAID use and heart failure.

Meanwhile, researchers find greater adherence to the Mediterranean diet could lower CVD risk.Lead author Dr. Nita Forouhi, of the Medical Research Council Epidemiology Unit at the University of Cambridge in the United Kingdom, and colleagues report their findings in the journal BMC Medicine.
Cardiovascular disease (CVD) refers to conditions that affect the heart and blood vessels, including stroke, heart attack, and heart disease.

Adopting a healthy diet is considered key for reducing the risk of CVD, and numerous studies have suggested the Mediterranean diet fits the bill.A study published in the European Heart Journal earlier this year, for example, found older adults who adhered to the Mediterranean diet were at lower risk of heart attack, stroke, and cardiovascular death than those who followed a Western diet.

The Mediterranean diet is typically high in plant-based foods – such as fruits, vegetables, whole grains, and nuts – and low in red meats and unhealthy fats. It also incorporates regular consumption of fish and poultry, and red wine is acceptable in moderation.

For their study, Forouhi and team set out to investigate how adhering to a Mediterranean diet affects the risk of developing CVD, as well as what proportion of CVD cases and deaths might be prevented in the U.K. as a result of adherence to the diet.

The team analyzed data from 23,902 healthy adults who were a part of the EPIC-Norfolk Study – a multi-center cohort study of more than 30,000 British adults that mainly looks at the link between diet, lifestyle, and cancer.

As part of the study, participants completed food frequency questionnaires, which the researchers analyzed to determine adherence to the Mediterranean diet. They did so using a 15-point score based on guidelines from the Mediterranean Diet Foundation.

Over an average follow-up period of 12-17 years, the researchers identified 7,606 new cases of CVD among the participants, as well as 1,714 CVD deaths.
Compared with participants with low adherence to the Mediterranean diet, the researchers found that subjects with higher adherence to the diet were 6-16 percent less likely to develop CVD.