Ibuprofen poses heart risk in osteoarthritis
Ibuprofen has been singled
out by a study as posing a particularly high cardiovascular risk for patients with osteoarthritis.
The findings confirm fears that the drug interferes with
aspirin's blood-thinning properties and have 'significant public health implications', according to the researchers.
Cardiovascular outcomes in patients with osteoarthritis were much worse for patients on ibuprofen than those on naproxen or lumiracoxib.
Study leader Dr Michael Farkouh, associate professor of cardiology at Mount Sinai School of Medicine in New York, said the risk of cardiovascular events in high-risk patients on NSAIDs seemed to largely depend on the particular drug used. 'These findings, though limited by the small numbers, suggest caution is warranted in prescribing ibuprofen to high-risk patients.
'With the scarcity of long-term NSAID clinical trials in high-risk patients, these findings have immediate relevance to patients with arthritis at increased cardiovascular risk.'
As many as 2.14 per cent of high-risk aspirin-users who took ibuprofen suffered a stroke, cardiovascular death or non-fatal myocardial infarction, compared with 0.25 per cent with lumiracoxib.
A second sub-study of the 18,325-patient trial compared lumiracoxib and naproxen, with cardiovascular events occurring in 1.48 and 1.58 of patients respectively.
Congestive heart failure occurred in 1.28 per cent of patients on ibuprofen, compared with 0.14 per cent of those on either naproxen or lumiracoxib.
Dr Iain Gilchrist, treasurer of the Primary Care Rheumatology Society and a GP in Bishop's Stortford, Essex, said the new results supported the suggestions from previous work. 'I don't think it's a very strong association but there does seem to be one between ibuprofen and
cardiovascular risk. Naproxen seems to be the drug of choice on current evidence.'
Dr Jim Kennedy, RCGP prescribing spokesman, said: 'NSAIDs have significant potential for interactions and side-
effects. We know about GI and we're increasingly aware of CV. Be particularly careful of people with renal, CV and GI risks.'
The results were published online by the journal Annals of the Rheumatic Diseases.
• 'Ibuprofen treatment in low-dose aspirin users was associated with increased incidence of composite cardiovascular events in patients at high risk compared with lumiracoxib'
• 'Naproxen 500mg twice daily equivalent in safety to 400mg lumiracoxib doses'
• 'Patients at high cardiovascular risk given ibuprofen had significantly higher incidence of congestive heart failure than patients administered lumiracoxib'