Common Painkiller Linked to Heart Failure Risk in Older Adults
New study finds pregabalin use may increase risk of heart failure in seniors with chronic pain, especially those with cardiovascular disease.
A large Medicare study found that older adults prescribed pregabalin for chronic pain had a 48% higher risk of developing heart failure compared to those prescribed gabapentin, with risk rising to 85% in patients with existing cardiovascular disease.
Study Details
Chronic pain affects nearly one in three adults over 65, and non-opioid medications like pregabalin and gabapentin are frequently used to manage symptoms. Pregabalin, though more potent, may lead to sodium and water retention that stresses the heart.
Researchers from Columbia University evaluated 246,237 Medicare beneficiaries (aged 65–89) who initiated pregabalin or gabapentin between 2014 and 2018. None had a prior history of heart failure.
Methodology
The team used inverse probability of treatment weighting across 231 patient variables to reduce bias and mimic a controlled trial. Patients were followed for heart failure outcomes, including hospitalizations and emergency visits.
Key Findings
Heart failure incidence: Pregabalin users had 18.2 cases per 1,000 person-years vs 12.5 for gabapentin users.
Overall risk: Pregabalin was linked with a 48% higher risk of new-onset heart failure
In patients with cardiovascular disease: Risk increased by 85%.
Outpatient diagnoses: Slightly elevated risk.
Mortality: No difference in all-cause mortality between groups.
Implications for Practice
For clinicians:
Pregabalin should be prescribed with caution in older adults, especially those with known cardiovascular disease.
A baseline heart evaluation may be warranted before starting pregabalin therapy.
Gabapentin may represent a safer alternative for pain control in this population.
For patients:
Older adults on pregabalin should be aware of heart failure symptoms like swelling, shortness of breath, and sudden weight gain.
Discuss with your physician whether gabapentin or other pain treatments may be safer options if you have heart disease.
The findings align with current European Medicines Agency recommendations and the American Heart Association’s warnings, reinforcing the need for careful prescribing.