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Association of outpatient utilisation of non-steroidal anti-inflammatory drugs and hospitalised heart failure in the entire Swedish population

Merlo, Juan LU ; Broms, Kristian LU ; Lindblad, Ulf LU ; Björck-Linne, Agneta; Liedholm, Hans LU ; Östergren, Per-Olof LU ; Erhardt, Leif RW LU ; Råstam, Lennart LU and Melander, Arne LU (2001) In European Journal of Clinical Pharmacology 57(1). p.71-75
Abstract
Objective: Individual-based studies on restricted geographical settings have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may precipitate congestive heart failure. As NSAID use is very extensive, it might increase the occurrence of symptomatic heart failure in the general population. Therefore, in order to study the impact of NSAID utilisation (prescribed and over the counter) on hospitalised heart failure in an entire country (Sweden), we performed an ecological analysis, a design appropriate for studying large geographical areas. Methods: We employed weighted (population size) ecological linear regression to study the association between outpatient utilisation of NSAIDs during 1989-1993 and hospitalised heart failure in... (More)
Objective: Individual-based studies on restricted geographical settings have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may precipitate congestive heart failure. As NSAID use is very extensive, it might increase the occurrence of symptomatic heart failure in the general population. Therefore, in order to study the impact of NSAID utilisation (prescribed and over the counter) on hospitalised heart failure in an entire country (Sweden), we performed an ecological analysis, a design appropriate for studying large geographical areas. Methods: We employed weighted (population size) ecological linear regression to study the association between outpatient utilisation of NSAIDs during 1989-1993 and hospitalised heart failure in 1993 in 283 of Sweden's 288 municipalities. Data were adjusted for age and ender proportions, socio-economic factors, latitude and utilisation of cardiovascular drugs, aspirin, low-dose aspirin and paracetamol. Results: The unadjusted relative risk of hospitalised heart failure for each increase of one standard deviation of NSAID utilisation (5.8 defined daily doses/1000 inhabitants/day) was 1.23 [95% confidence interval (CI) 1.18, 1.27]. After adjustments, the relative risk was 1.08 (95% CI 1.04, 1.12); the corresponding values if aspirin (non-low-dose) was included as an NSAID were 1.26 (95% CI 1.23, 1.28) and 1.07 (95% CI 1.04, 1.10). There was no such adjusted association with the utilisation of paracetamol - 0.95 (95% CI 0.92, 0.98). Conclusion: The NSAID-heart failure association already established by individual-based studies on restricted geographical settings was corroborated in the present ecological study based on the whole population of an entire country (Sweden). Efforts should be made to promote a rational use of NSAIDs in the general population. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
NSAID, Heart failure, Ecological studies
in
European Journal of Clinical Pharmacology
volume
57
issue
1
pages
71 - 75
publisher
Springer
external identifiers
  • scopus:0035036049
ISSN
1432-1041
DOI
10.1007/s002280100266
language
English
LU publication?
yes
id
8c67bb6d-26c1-44cb-9887-67b1931046ae (old id 1122760)
date added to LUP
2008-07-04 16:08:23
date last changed
2018-05-29 10:58:59
@article{8c67bb6d-26c1-44cb-9887-67b1931046ae,
  abstract     = {Objective: Individual-based studies on restricted geographical settings have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may precipitate congestive heart failure. As NSAID use is very extensive, it might increase the occurrence of symptomatic heart failure in the general population. Therefore, in order to study the impact of NSAID utilisation (prescribed and over the counter) on hospitalised heart failure in an entire country (Sweden), we performed an ecological analysis, a design appropriate for studying large geographical areas. Methods: We employed weighted (population size) ecological linear regression to study the association between outpatient utilisation of NSAIDs during 1989-1993 and hospitalised heart failure in 1993 in 283 of Sweden's 288 municipalities. Data were adjusted for age and ender proportions, socio-economic factors, latitude and utilisation of cardiovascular drugs, aspirin, low-dose aspirin and paracetamol. Results: The unadjusted relative risk of hospitalised heart failure for each increase of one standard deviation of NSAID utilisation (5.8 defined daily doses/1000 inhabitants/day) was 1.23 [95% confidence interval (CI) 1.18, 1.27]. After adjustments, the relative risk was 1.08 (95% CI 1.04, 1.12); the corresponding values if aspirin (non-low-dose) was included as an NSAID were 1.26 (95% CI 1.23, 1.28) and 1.07 (95% CI 1.04, 1.10). There was no such adjusted association with the utilisation of paracetamol - 0.95 (95% CI 0.92, 0.98). Conclusion: The NSAID-heart failure association already established by individual-based studies on restricted geographical settings was corroborated in the present ecological study based on the whole population of an entire country (Sweden). Efforts should be made to promote a rational use of NSAIDs in the general population.},
  author       = {Merlo, Juan and Broms, Kristian and Lindblad, Ulf and Björck-Linne, Agneta and Liedholm, Hans and Östergren, Per-Olof and Erhardt, Leif RW and Råstam, Lennart and Melander, Arne},
  issn         = {1432-1041},
  keyword      = {NSAID,Heart failure,Ecological studies},
  language     = {eng},
  number       = {1},
  pages        = {71--75},
  publisher    = {Springer},
  series       = {European Journal of Clinical Pharmacology},
  title        = {Association of outpatient utilisation of non-steroidal anti-inflammatory drugs and hospitalised heart failure in the entire Swedish population},
  url          = {http://dx.doi.org/10.1007/s002280100266},
  volume       = {57},
  year         = {2001},
}