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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