Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study

• Published in: The Lancet (British edition) 2004-05, Vol.363 (9423), p.1751-1756
• Main Authors: Mamdani, Muhammad, Juurlink, David N, Lee, Douglas S, Rochon, Paula A, Kopp, Alex, Naglie, Gary, Austin, Peter C, Laupacis, Andreas, Stukel, Therese A
• Format: Article
• Language: English
• Subjects: Aged; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis; Biological and medical sciences; Blood pressure; Cardiology. Vascular system; Celecoxib; Clinical outcomes; Cohort analysis; Cohort Studies; Congestive heart failure; COX-2 inhibitors; Cyclooxygenase Inhibitors - adverse effects; Cyclooxygenase Inhibitors - therapeutic use; Cyclooxygenase-2; Drug therapy; Drug toxicity and drugs side effects treatment; Drug use; Edema; Female; Geriatrics; Health risk assessment; Heart; Heart failure; Heart Failure - chemically induced; Heart Failure - complications; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart rate; Hospitalization; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Identification methods; Inflammation; Inhibitors; Lactones - adverse effects; Lactones - therapeutic use; Male; Medical sciences; Nonsteroidal anti-inflammatory drugs; Older people; Osteoarthritis; Oxygenase; Patients; Pharmacology. Drug treatments; Population; Population studies; Population-based studies; Prescription drugs; Proportional Hazards Models; Prostaglandin endoperoxide synthase; Pyrazoles; Ratios; Retrospective Studies; Risk; Risk Factors; Rofecoxib; Sulfonamides - adverse effects; Sulfonamides - therapeutic use; Sulfones; Toxicity: cardiovascular system
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(04)16299-5

Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of congestive heart failure, but little is known about the cardiovascular effects of a newer group of NSAIDS called selective cyclo-oxygenase (COX)-2 inhibitors. We aimed to compare rates of admission for congestive heart failure in elderly patients who were newly dispensed COX-2 inhibitors or non-selective NSAIDs. In this population-based retrospective cohort study we identified NSAID-naive individuals aged 66 years or older, who were started on rofecoxib (n=14,583), celecoxib (n=18,908), and non-selective NSAIDs (n=5,391), and randomly selected non-NSAID users as controls (n=100,000). Relative to non-NSAID users, patients on rofecoxib and non-selective NSAIDS had an increased risk of admission for congestive heart failure (adjusted rate ratio 1·8, 95% CI 1·5–2·2, and 1·4, 1·0–1·9, respectively), but not celecoxib (1·0, 0·8–1·3). Compared with celecoxib users, admission was significantly more likely in users of non-selective NSAIDs (1·4, 1·0–1·9) and rofecoxib (1·8, 1·4–2·4). Risk of admission for rofecoxib users was higher than that for non-selective NSAID users (1·5, 1·1–2·1). Of patients with no admission in the past 3 years, only rofecoxib users were at increased risk of subsequent admission relative to controls (1·8, 1·4–2·3). These findings suggest a higher risk of admission for congestive heart failure in users of rofecoxib and non-selective NSAIDs, but not celecoxib, relative to non-NSAID controls.