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Ibuprofen Risky for Heart Patients?

Common Pain Drug May Cut Aspirin Lifeline in People at High Risk for Heart Disease

Ibuprofen or Naproxen vs. Prexige continued...

All of the high-heart-risk patients in the Farkouh study should have been taking low-dose aspirin. Sixty percent of them did. These patients should have had fewer heart attacks, strokes, and heart deaths than those who did not take aspirin.

But if the patients took aspirin and also took high-dose ibuprofen, they were nine times more likely to have a heart attack than were patients who took aspirin and Prexige. Patients who took ibuprofen without taking aspirin were no more likely to have a heart attack than those who took Prexige.

Farkouh and Nissen say there is strong evidence that ibuprofen blocks the blood-clot-preventing effects of aspirin. Both agree that the drugs do not interact if a person takes aspirin two hours before taking ibuprofen. But Farkouh says this approach will not work in the real world.

“The problem with that is Grandma Jones has to take a statin drug, an ACE inhibitor, and beta-blockers, too. Now you tell her to take a white pill hours before she takes the green pill -- it isn't going to work," he says.

So what is a person who needs low-dose aspirin supposed to do for arthritis pain? For those at low risk of stomach and gut side effects, Farkouh recommends taking naproxen at the lowest helpful dose -- and avoiding ibuprofen.

Nissen says there's far too little evidence to advise anyone to stop taking ibuprofen. However, he recommends that patients take their low-dose aspirin two hours before taking ibuprofen.

Answers Won't Come Soon

Nissen and colleagues are conducting a clinical trial that he and Farkouh agree should answer the ibuprofen question once and for all. That trial, now enrolling 20,000 patients, will compare Celebrex, naproxen, and ibuprofen in patients at risk of heart disease.

In that trial, patients will take their aspirin two hours before taking their study medication.

The good news is the trial will, at last, provide sorely needed information on the relative heart risks of common pain relievers.

The bad news: The study won't start returning results until 2010.

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