Consumption of NSAIDs and the Development of Congestive Heart Failure in Elderly Patients

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Abstract
THE BENEFICIAL and harmful effects of nonsteroidal anti-inflammatory drugs (NSAIDs) are related primarily to their inhibition of prostaglandin synthesis.1 Although prostaglandins have both vasodilator and vasoconstrictor actions, the overall effects of NSAIDs are to raise systemic vascular resistance and to reduce renal perfusion in susceptible individuals.2,3 In some individuals with impaired ventricular function, these mechanisms can exacerbate their tendency to develop congestive heart failure (CHF).3 There have been experimental studies demonstrating the deleterious hemodynamic effects of NSAIDs in persons with preexisting CHF.3 However, there have been few pharmacoepidemiological studies designed to estimate the risk of CHF in users of NSAIDs in the population.4 NSAIDs are widely used by elderly patients.1 Congestive heart failure is a common reason for admission to the hospital, and is associated with poor survival following discharge from the hospital.5-7 A modest increase in the risk of this condition in users of NSAIDs (compared with nonusers) could translate into a substantial increase in morbidity and mortality, both for the individual user and for the community.