Benzodiazepines and heart failure: a meta-analysis finds an association, not causation

Eleven studies, with very different follow-up periods

The researchers searched seven databases through August 7, 2025. They included eleven studies, with follow-up periods ranging from 180 days to 15 years. Their review examines the onset of heart failure and hospitalizations related to the condition.

The results were pooled using a random-effects model. However, the abstract consulted does not specify the total sample size, detailed population characteristics, or the doses and durations of benzodiazepine use. It therefore does not allow us to determine which patient profile the results best apply to.

A signal compared with non-use

Compared with non-use, benzodiazepine use was associated with a hazard ratio of 1.41 for the onset of heart failure, with a 95% confidence interval of 1.16 to 1.72. For hospitalizations related to the condition, the hazard ratio was 1.29, with an interval of 1.01 to 1.65.

These measures describe a relative difference in the occurrence of events during follow-up. They do not provide the number of additional cases for a given number of patients. Since absolute risks are not included in the abstract, the practical magnitude of the signal remains difficult to assess.

The comparison between medications remains incomplete

The abstract also reports a signal of increased hospitalizations and rehospitalizations compared with antipsychotics, Z-drug hypnotics, and suvorexant. However, it does not provide numerical estimates for these comparisons.

These results are therefore insufficient to rank insomnia treatments by cardiac safety or to identify a preferable alternative for a given individual.

What this review changes

The main contribution is a signal warranting caution, particularly in people at risk of heart failure. A major obstacle to a causal conclusion remains: differences between users and non-users could contribute to the observed associations, and the abstract does not allow their influence to be assessed.

If you take a benzodiazepine to sleep and have a cardiac risk, this publication can serve as a starting point for discussion with your prescriber. On its own, it is not a reason to change your treatment.

What we can take away

This meta-analysis strengthens a signal calling for vigilance about cardiac risk with benzodiazepines. It demonstrates neither causation nor the superiority of another insomnia treatment.