The research compared the cardiovascular health of 18,523 osteoarthritis patients over 50 years of age who were all taking high doses of one of three pain medications, either lumiracox­ib (e.g. Prexige, sometimes misquoted as “Prestige” by the media), ibuprofen (e.g. Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin) or naproxen (e.g. Aleve, Anaprox, Naprogesic, Naprosyn, Naprelan, Synflex).

The study group included patients considered at high risk for “cardiovascular events” -mostly heart attacks. Some of these patients were taking low-dose aspirin, a common preventa­tive treatment that helps thin the blood to help prevent blood clots, and some who were not tak­ing any aspirin. In the patients taking low-dose aspirin, ibuprofen was associated with a dramat­ically higher incidence of heart attacks than either lumiracoxib or naproxen. The researchers concluded that ibuprofen must somehow interfere with the protective blood thinning properties of aspirin.

Medications such as lumiracoxib are called “selective COX-2 inhibitors”, which is a type of NSAID (nonsteroidal anti-inflammatory drug). Medications such as ibuprofen and naproxen are called “non-selective non-steroidal anti-inflammatory drugs” or NSAIDs. Aspirin itself was the first discovered member of the NSAID class of drugs.

According to the National Institutes of Health, selective COX-2 inhibitors and NSAIDs both increase the risk of heart attacks, which may happen without warning and may cause death when aspirin is not present. But research had been lacking in the high cardiovascular risk popu­lation of patients taking aspirin in combination with these pain medicines used for osteoarthri­tis.

“Ibuprofen has a significantly higher rate of major cardiovascular events, mostly heart attacks, when compared to a COX-2 inhibitor,” said Dr. Michael E. Farkouh, M.D., of Mount Sinai, the lead investigator. “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.

“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.”

SOURCE: Mount Sinai School of Medicine, Press Release, April 2007 http://fusionanssm.edu/media/content.cfm?storynum=31 (All brand name drugs listed above are registered traademarks of their manufacturer.)