Ibuprofen May Boost Aspirin Users' Heart Risk

Study of arthritis patients needs to be confirmed, experts say

WEDNESDAY, April 4, 2007 (HealthDay News) -- Ibuprofen, the popular over-the-counter painkiller found in Advil and Motrin, may increase the odds of heart problems in patients who have osteoarthritis and are taking daily aspirin to help lower their cardiovascular risk, a new study finds.

The authors of the study, published in the Annals of the Rheumatic Diseases, speculated that ibuprofen may cancel out the cardio-protective effects of daily low-dose aspirin.

Use of ibuprofen and aspirin boosted arthritis patients' one-year heart attack and stroke risk ninefold compared to patients who were taking a cox-2 inhibitor pain reliever, the study found.

"This adds more data to the fact that perhaps ibuprofen inhibits aspirin in a clinically significant way," said Dr. E. Scott Monrad, director of interventional cardiology at Montefiore Weiler Division in New York City. "The most reassuring thing is that the event rate seen in the study, even in the high-risk arm, is still pretty low," added Monrad, who was not involved in the study.

Another expert agreed that it's not yet time to panic.

"You can't draw firm conclusions from this paper, but it raises the question that perhaps we should do a formal study looking at ibuprofen versus some of these other agents in patients who are at high cardiovascular risk and seeing if it really does hold up," said Dr. Robert Scott III, assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, College Station, and senior staff cardiologist at Scott & White Hospital.

Previous studies have suggested that drugs known as cox-2 inhibitors, as well as non-selective nonsteroidal anti-inflammatory drugs (NSAIDs), increase the risk of cardiovascular events. The cox-2 inhibitor Vioxx was withdrawn from the market in 2004 after studies found that it might double the risk of heart attacks, and the withdrawal of a second cox-2, Bextra, followed soon after.

But there has not been much detailed research in patients who are at a high risk of cardiovascular problems and who are taking aspirin. Aspirin thins the blood and therefore reduces the risk of heart attacks and other cardiovascular events.

Previous studies have suggested that ibuprofen may interfere with aspirin's heart-healthy effects.

"Most of the data that's been generated in the past has been carried out in patients who do not have overt cardiac disease," explained Dr. Michael Farkouh, lead author of the study and director of the Mount Sinai Heart Clinical Trials in New York City. "We really have not studied cardiac patients that thoroughly."

For this study, investigators revisited data on more than 18,000 individuals over the age of 50 with osteoarthritis, comparing the cox-2 inhibitor Prexige (lumiracoxib) with either ibuprofen or naproxen.

Ibuprofen and naproxen (brand name Aleve) are both traditional NSAIDs.

The study was funded by Novartis, the drug company that developed Prexige.

Ten percent of the participants were at high risk for a heart attack or stroke and some were taking low-dose aspirin (70 to 100 milligrams per day).

Individuals at low risk for cardiovascular disease had about the same number of heart attacks and strokes, regardless of which drug they were taking.

But high-risk patients taking aspirin and ibuprofen were about nine times more likely to have heart attacks and strokes over one year as those taking Prexige.

People taking ibuprofen were also more likely to develop congestive heart failure than those taking the cox-2 inhibitor.

The absolute risk of a problem was still low, with about 2.14 percent of those in the ibuprofen group suffering an event, versus 0.25 percent in the Prexige group.

The findings, if borne out, could be concerning, because ibuprofen is so easily available. "If cardiac patients take ibuprofen over-the-counter, that's a danger, because doctors aren't aware of it," Farkouh said. "It blocks the effect of aspirin, so there's more heart failure, more heart attacks, more hypertension. It's an important public health message."

More information

There's more on aspirin at the American Heart Association.

SOURCES: Michael Farkouh, M.D., director, Mount Sinai Heart Clinical Trials, and associate professor, medicine, Mount Sinai School of Medicine, New York City; E. Scott Monrad, M.D., director, interventional cardiology, Montefiore Weiler Division, New York City; Robert Scott III, M.D., assistant professor, internal medicine, Texas A&M Health Science Center College of Medicine, College Station, and senior staff cardiologist, Scott & White Hospital; April 2007, Annals of the Rheumatic Diseases
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