LONDON (AP) -- Fresh evidence adds to suspicions that ibuprofen could be dangerous for most heart patients because it can block the blood-thinning benefits of aspirin.
February 14, 2003
By Mary Pickett, M.D.
Harvard Medical School
How does this article relate to me?
It is Valentine's Day, so it is a good day to think about hearts. Although research that relates ibuprofen to a possible increase in heart disease is concerning, the evidence is not strong enough for doctors to stop using this useful medicine or others in its class.
Aspirin is known to reduce the risk for a heart attack by thinning the blood. Doctors have collected a small amount of evidence that suggests that ibuprofen may block aspirin's blood-thinning effect. Aspirin thins the blood by attaching to an enzyme known as "COX-1." Ibuprofen molecules can make the same attachments, but ibuprofen's attachments do not lead to blood thinning. Last year, a researcher reported on a small handful of people that he had studied. When a person in his study took aspirin two hours before ibuprofen, blood tests showed that the blood was thinned very effectively. But when a person took ibuprofen two hours before aspirin, the blood was not thinned very well. This researcher introduced the idea that ibuprofen, when taken first, might take up most or all of the available "parking spots" on the COX-1 enzyme, preventing aspirin from having its protective effect.
Doctors who were interested in this idea studied the hospital records of people who had heart disease. After a person was diagnosed with heart disease, they asked, did that person have a shorter life expectancy if he or she took both ibuprofen and aspirin, as opposed to a person taking aspirin alone? Their findings did find shorter survival in the group that took ibuprofen. In these patients, there was not a specific time of day that each of the two medicines was taken. It is possible that ibuprofen prevented aspirin from having its full blood-thinning effect. However, the survival difference could just as easily have occurred because the people on ibuprofen were treating additional illnesses or inflammation.
Two circulatory problems that ibuprofen can worsen are heart failure and hypertension. Ibuprofen blocks the production of "prostaglandins," body proteins that relax your arteries, among other things. Without the prostaglandin effect on arteries, hearts that are prone to failure have a harder time pumping. Without prostaglandins, also, many commonly used high blood pressure medications have a weaker effect.
What changes do I need to make?
Ibuprofen and other non-steroidal anti-inflammatory drugs are excellent medications for treating pain. We do not have enough information to recommend that all heart disease patients stop them. But here are some important steps to take:
- If you take ibuprofen and have heart disease, it may be wise to take your aspirin at least two hours before your first dose of ibuprofen that day.
- If you have heart failure, avoid ibuprofen and other non-steroidal anti-inflammatory drugs.
- If you have hypertension, check your blood pressure after using ibuprofen or other non-steroidal anti-inflammatory agents and avoid these medicines if your blood pressure increases with their use.
What can I expect in the future?
The studies examining ibuprofen and its possible interaction with aspirin have not been large and have not assigned treatments randomly. It is notable that their authors have had an affiliation with pharmaceutical companies marketing competing drugs. The safety of ibuprofen for people who have heart disease will not be fully known until trials of higher quality are completed.
Related Areas:
Heart And Circulatory
