OLDER adults prescribed pregabalin for noncancer chronic pain have a higher risk of developing heart failure compared to those given gabapentin, according to a large retrospective cohort study of Medicare beneficiaries in the United States. This elevated risk is most prominent among patients with a prior history of cardiovascular disease.
Chronic pain is common in the older population, with up to 30% affected, and gabapentin as well as pregabalin are widely used non-opioid medications to manage it. While pregabalin has a stronger affinity for the calcium channels involved in pain signalling, there has been limited direct comparison of its potential cardiovascular risks relative to gabapentin in clinical populations.
In this study, researchers analysed the records of 246,237 Medicare beneficiaries aged 65 to 89 years with chronic noncancer pain but without heart failure or terminal illness, who newly initiated either pregabalin (18,622 patients) or gabapentin (227,615 patients) between January 2015 and December 2018. The primary outcome was hospital admission or emergency department attendance for heart failure. Over 114,113 person-years of follow-up, heart failure occurred at a rate of 18.2 per 1,000 person-years for pregabalin users and 12.5 per 1,000 person-years for gabapentin users, with an adjusted hazard ratio of 1.48 (95% CI, 1.19-1.77). Among those with a background of cardiovascular disease, the risk increase was greater (AHR, 1.85; 95% CI, 1.38-2.47). Outpatient diagnoses of heart failure were also more frequent for pregabalin (AHR, 1.27; 95% CI, 1.02-1.58). Importantly, there was no significant difference in all-cause mortality (AHR, 1.26; 95% CI, 0.95-1.76).
The results suggest that pregabalin should be prescribed with particular caution in older adults, especially those with existing cardiovascular concerns. Clinicians are urged to consider individual risk profiles when selecting between these medications, and to monitor patients closely.
Reference
Park EE et al. Initiation of pregabalin vs gabapentin and development of heart failure. JAMA Netw Open. 2025;8(8):e2524451.
