August 25, 2003 — If you take ibuprofen daily, listen up: You may get less heart attack protection from aspirin.
That’s the suggestion from a new study, appearing in this month’s Circulation, published by the American Heart Association.
Aspirin is the first line of defense in preventing heart disease, because it blocks a critical substance — the Cox-1 enzyme — that leads to clots that can cause heart attacks.
But over-the-counter, anti-inflammatory pain relievers like ibuprofen (non-steroidal anti-inflammatories or NSAIDs) also interact with this Cox-1 enzyme to reduce inflammation and pain. Researchers have speculated these drugs might interfere with the heart-protective action of aspirin. In this study, it looks like they did.
“It’s too early to make recommendations or put a warning label on bottles — but if the patient was a regular NSAID user, it did interfere with aspirin,” says lead researcher Tobias Kurth, MD, an epidemiologist in Preventive Medicine at Brigham and Women’s Hospital in Boston.
One important caveat: Casual or intermittent anti-inflammatory use did not interfere with aspirin’s heart-protective effects, he tells WebMD.
In Kurth’s five-year study more than 22,000 healthy male doctors, half took 325 mg aspirin on alternate days; half took a placebo.
The aspirin group had 44% fewer heart attacks than the placebo group — 139 heart attacks in the aspirin group; 239 in the placebo group.
Those who regularly took ibuprofen and other common anti-inflammatory drugs did not get that protective effect.
However, relatively few heart attacks were seen in those who took them intermittently — on less than 60 days per year. The aspirin still provided protection from heart attacks.
The combined regular use of aspirin and anti-inflammatory pain relievers — more than 60 days per year — was associated with a twofold greater risk of heart attacks compared with those not taking the combination.
Don’t Stop NSAIDs Yet
Because aspirin and anti-inflammatory pain relievers work slightly differently in the body, there may be a simple solution, Kurth tells WebMD. “It may be that if you take aspirin a couple of hours before taking the NSAID, they may not interfere with each other. However, we need more data on that. Other groups are researching that question.”
Timing the dosage could work, since aspirin is taken only once a day and NSAIDS are taken throughout the day, especially during an acute arthritis episode, says Hooshang Bolooki, MD, a cardiovascular surgeon with the University of Miami School of Medicine.
“After coronary bypass surgery, we uniformly put patients on aspirin — almost 100% of patients get aspirin,” Bolooki tells WebMD. “I think, when more research is done on this, we will find that aspirin is doing something to prevent heart attacks. The NSAID just makes it a bit less effective.”