Ibuprofen appears to interfere with the beneficial effects of low-dose aspirin in patients at high risk for cardiovascular disease
The nonsteroidal anti-inflammatory drug ibuprofen appears
to interfere with the beneficial effect of low-dose aspirin, causing a significantly
increased risk for myocardial infarction in patients at high risk for cardiovascular
disease, according to an article published online April 5 by Annals of the Rheumatic
Diseases.
The current study was the first to study outcomes in
high-risk patients who have osteoarthritis. The researchers compared combination
treatments of low-dose aspirin with ibuprofen, naproxen, and the Cox-2 inhibitor
lumiracoxib. They found that high-risk patients taking the combination of ibuprofen
and aspirin were nine times more likely to have a myocardial infarction than patients
who took aspirin and the selective Cox-2 inhibitor.
“Ibuprofen has a significantly higher rate of major cardiovascular
events, mostly heart attacks, when compared to a COX-2 inhibitor,” said Michael
E. Farkouh, MD, of Mount Sinai Heart, lead investigator of Therapeutic Arthritis
Research and Gastrointestinal Event Trial ? High Risk (TARGET- HR) and Associate
Professor of Medicine and Cardiology at Mount Sinai School of Medicine. “The findings
underscore the importance of not only considering the class of NSAIDs used in
high risk cardiac patients with osteoarthritis but also making physicians aware
of the interaction of NSAIDs with aspirin, diminishing any beneficial effects.”
The TARGET-HR Trial involved 18,523 patients over 50
years of age with osteoarthritis who took a high dose of the Cox-2 inhibitor lumiracoxib
or one of the two non-selective Cox-inhibitors, ibuprofen or naproxen.
Among patients at high risk for cardiovascular disease
who did not take low-dose aspirin, the rate of infarction was higher for lumiracoxib
than for naproxen but not higher than for ibuprofen. However, in high-risk patients
who took low-dose aspirin, ibuprofen was associated with a higher incidence of
cardiovascular events than lumiracoxib or naproxen.
“This is the first randomized trial evidence to show
risk of interaction between ibuprofen and aspirin to be real,” said Farkouh. “Doctors
should not give high-risk cardiovascular patients ibuprofen for pain while they
are taking aspirin for their heart. Cardiologists, rheumatologists and gastroenterologists
need to work together to fully evaluate the evidence at hand to make proper recommendations
to primary care physicians.”
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