NSAIDs May Increase Risk of Atrial Fibrillation in Older Patients

Usage of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of atrial fibrillation (AF) in older patients, according to a study in the Netherlands.

The study, by Bruno Stricker, MB, PhD, and colleagues at Erasmus Medical Center in Rotterdam, analyzed data from more than 8,400 people, who were being followed by the Rotterdam Study. Since 1990, this study has been following the health of people 55 years and older living in one area of Rotterdam. The results were published in the online journal BMJ Open on April 8, 2014.

During the follow-up period of nearly 13 years, 857 of the study participants developed AF. Current, chronic users of NSAIDs had a 76% higher risk of AF than never users. The risk remained after researchers controlled for age, sex, and heart problems. For people who used NSAIDs within the previous month, the risk for AF rose to 84%.

According to the researchers, the results of the study suggest that “the increased risk occurs shortly after starting treatment and may disappear over time.” One reason might be because those with symptoms may have discontinued their drug use.

Even though risk appeared to be higher with larger doses of prescription NSAIDs, the trend was not significant.

Stricker believes the association between AF and NSAIDs suggests a cause-and-effect relationship and hypothesized that prescription NSAIDs may be linked with fluid retention, leading to a rise in blood pressure. However, the need to take prescription-strength NSAIDs may also suggest underlying inflammation, which raises the risk of AF.

The study is only able to show an association between prescription NSAIDs and increased risk for AF because it did not examine the use of nonprescription NSAIDs.

In response to the study, Steve Scarff, the director of Regulatory and Scientific Affairs at the Australian Self Medication Industry, wanted to reassure consumers of their use of over-the-counter NSAIDs.

“Importantly, this study did not demonstrate any increase in AF risk in patients who were currently using an NSAID for fewer than 15 days,” Scarff said in a statement. “This duration is much longer than the recommended use of any over-the-counter NSAID.”

The researchers suggest further studies to investigate the reasons behind the association between NSAIDs and AF.