Ibuprofen Risky for Heart Patients?
Common Pain Drug May Cut Aspirin Lifeline in People at High Risk for Heart Disease
April 4, 2007 -- The common painkiller ibuprofen may boost heart attack risk
by blocking the lifesaving effects of aspirin, a controversial study shows.
“The public health impact of this is monstrous," Michael Farkouh, MD,
MPH, director of clinical trials at Mount Sinai Heart, tells WebMD.
“Ibuprofen is relatively safe except when we give it with aspirin to people
at high risk of heart attack," Farkouh says. "Only when given with
aspirin do we see an excess of heart attacks."
Farkouh admits this is a controversial conclusion -- and that the study,
which was not designed to look at ibuprofen safety, does not prove that
ibuprofen is harmful to people at high risk of heart disease.
But he says the study provides a clear warning sign that ibuprofen is risky
for people who need the blood-clot-reducing effect of daily low-dose
“Those taking aspirin in the ibuprofen arm of the study had a ninefold
excess of heart attacks," Farkouh says.
Steve Nissen, MD, chairman of cardiovascular medicine at The Cleveland
Clinic and past president of the American College of Cardiology, urges caution.
He notes that the findings are based on only eight heart attacks among
thousands of high-risk patients taking ibuprofen and aspirin.
“The hazard ratio here is not relevant. It is not something I would
trumpet," Nissen tells WebMD. “This is not to say Dr. Farkouh is not right.
We have to be careful here. If we jump to conclusions, we may do more harm than
Farkouh says the numbers may be small but the potential risks are great. And
it would not be the first time that relatively small numbers of heart attacks
caused a major change in how doctors look at pain drugs.
“The whole Vioxx thing was based on 64 heart events among 21,000 patients
studied," Farkouh says. "Here we are talking about potentially a higher
magnitude of impact. The interaction of ibuprofen with aspirin is a bigger
public health concern than Vioxx was."
Farkouh and colleagues report their findings in the early online issue of
the BMJ specialty journal Annals of the Rheumatic Diseases.
Ibuprofen or Naproxen vs. Prexige
The study by Farkouh and colleagues enrolled 18,325 arthritis patients.
Nearly 17% of these patients were at high risk of heart attack and stroke.
The trial compared ibuprofen (brand names include Advil, Motrin, and Nuprin)
or naproxen (Aleve, Naprosyn) to a new pain drug sold as Prexige in the U.K.
Prexige is a member of the stomach-friendly family of pain drugs called
Cox-2 inhibitors. Celebrex is the only member of this drug class sold in the
U.S. Another Cox-2 drug, Vioxx, was taken off the market after people taking
the drug had a suspiciously high number of heart attacks.