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NSAIDs seem to increase the risk of atrial fibrillation (AF), according to a study in BMJ Open, which enrolled 423 people without the arrhythmia at baseline.

Patients were aged, on average, 68.5 years and 58 per cent were women. During a mean follow-up of 12.9 years, 10.2 per cent developed AF.

Using NSAIDs for 15-30 days before the AF diagnosis increased the risk by 76 per cent compared with controls (who never used NSAIDs) after adjusting for age, sex and cardiovascular risk factors.

Using NSAIDs within the preceding 30 days increased AF risk by 84 per cent. Higher doses seemed to increase AF risk, although this did not reach statistical significance. The authors point out the study might have missed OTC NSAIDs.

Several mechanisms could link AF and NSAIDs. For instance, NSAIDs may raise blood pressure by enhancing fluid retention, increasing peripheral resistance and attenuating the effects of diuretics and antihypertensives.

NSAIDs may also induce changes in the size of the left ventricle or indicate underlying inflammatory disease, both of which might increase AF risk. Further studies are needed to elucidate the mechanisms. (2014; 4:e004059)