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No Increased Risk of Myocardial Infarction with Simultaneously Aspirin, Ibuprofen Use: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 21, 2002 -- The recommendation that patients on aspirin not take ibuprofen based on a concern about an increased cardiovascular risk seems to be unfounded, according to researchers.

There was no increased risk of myocardial infarction (MI) in patients who simultaneously consumed aspirin and ibuprofen compared to patients taking aspirin alone in a study by researchers at Durham Veterans Affairs Medical Center and Duke University Medical Center in Durham, North Carolina, United States.

Dr. Taral N. Patel reported the findings here November 20 at the 2002 Scientific Sessions of the American Heart Association (AHA).

Researchers reviewed outpatient prescriptions for aspirin and ibuprofen issued during a recent ten-year period at the Veterans Affairs Medical Center. Those who used aspirin and ibuprofen concurrently were matched against those who used aspirin only by race, sex, age within ten years, and cholesterol levels (either low-density lipoprotein or total cholesterol) to within 30 mg/dL. The rate-ratio of developing an MI per patient-month of drug exposure was then determined.

The study was prompted by previous laboratory research, which had suggested that the simultaneous use of aspirin and ibuprofen might attenuate the anti-platelet effect of aspirin, and would decrease its use as a cardio-protectant.

Results showed that the 3,859 patients who received both aspirin and ibuprofen developed 138 MIs, for a rate of 0.00265 MI's per patient month. The 10,239 patients who received aspirin only sustained 684 MIs, for a rate of 0.00437 MIs per patient month.

The rate ratio of having an MI was 0.61 (< 0.0001), favouring the group who took aspirin and ibuprofen simultaneously. .

An analysis of diabetic patients found a rate-ratio of 0.48 (< 0.0001).

"Although this is a limited study, there does not appear to be any increased risk of MI among patients who simultaneously consume aspirin and ibuprofen when compared to patients who take aspirin alone," Dr. Patel said.

The study, he added, demonstrated a 40 percent reduction in the rate of developing an MI when taking both aspirin and ibuprofen compared to the rate of MI with aspirin alone, and the rate reduction appeared to be even greater among patients with diabetes. A smaller but still significant effect was seen among all patients who consumed aspirin alone or aspirin and ibuprofen at different times.
"Given the significant renal and gastrointestinal toxicity of NSAIDS, we cannot advocate the use of combination therapy for cardiovascular prophylaxis. However recommendations that patients who take aspirin not take ibuprofen out of a concern of cardiovascular risk may be premature," he said.

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