Feenstra J, Grobbee D E, Mosterd A, Stricker B H
Department of Epidemiology and Biostatistics, Erasmus University Medical School Rotterdam, The Netherlands.
Drug Saf. 1997 Sep;17(3):166-80. doi: 10.2165/00002018-199717030-00003.
Congestive heart failure (CHF) is a complex clinical syndrome, especially in the elderly, which results from cardiac dysfunction. Epidemiological studies have shown a gradual increase in age-adjusted hospitalisation rates for CHF and overall population prevalence of CHF during the last 2 decades in Western countries. The healthcare costs associated with CHF are considerable and are likely to increase in the near future. Hence, identification of risk factors which could induce or exacerbate CHF is of major importance. NSAIDs are frequently prescribed in elderly patients for several rheumatological and nonrheumatological indications. Numerous adverse reactions, mainly related to the gastrointestinal tract and kidney function, have been described for NSAIDs. In addition, some case reports have suggested a causal relation between the use of NSAIDs and the onset of CHF. The pathophysiology of CHF and the pharmacological properties of NSAIDs support this hypothesis. In particular, the inhibition of prostaglandin synthesis may adversely affect cardiovascular homeostasis in patients with a propensity to develop CHF. Notwithstanding the adverse effects, however, the prescription of NSAIDs in elderly patients is often desirable and justifiable. Therefore, further pharmaco-epidemiological research is needed to quantify the risk for CHF attributable to the use of NSAIDs and to identify patients who are particularly susceptible to the adverse cardiovascular effects of these agents. In these patients, it may be advisable to avoid the use of NSAIDs.
充血性心力衰竭（CHF）是一种复杂的临床综合征，在老年人中尤为如此，它由心脏功能障碍引起。流行病学研究表明，在过去20年中，西方国家经年龄调整的CHF住院率和CHF在总人口中的患病率都在逐渐上升。与CHF相关的医疗费用相当可观，而且在不久的将来可能还会增加。因此，识别可能诱发或加重CHF的危险因素至关重要。非甾体抗炎药（NSAIDs）经常被开给老年患者用于多种风湿性和非风湿性适应症。NSAIDs有许多不良反应，主要与胃肠道和肾功能有关。此外，一些病例报告表明NSAIDs的使用与CHF的发病之间存在因果关系。CHF的病理生理学和NSAIDs的药理特性支持这一假设。特别是，前列腺素合成的抑制可能会对有发生CHF倾向的患者的心血管稳态产生不利影响。然而，尽管有这些不良反应，但在老年患者中使用NSAIDs往往是必要且合理的。因此，需要进一步开展药物流行病学研究，以量化因使用NSAIDs导致CHF的风险，并识别出对这些药物的不良心血管影响特别敏感的患者。对于这些患者，避免使用NSAIDs可能是明智的。
