Pain drugs have different heart risks

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The various anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which are used to treat arthritis and other painful conditions, differ in the risks of heart attacks and stroke, according to a report in the Annals of the Rheumatic Diseases. Much of the difference seems to depend on how the drug interacts with aspirin, which is commonly given to prevent heart attacks.

"Traditional NSAIDs, and ibuprofen in particular, do have the potential to interact with the effects of aspirin," Dr. Michael E. Farkouh from Mount Sinai School of Medicine, New York told Reuters Health. "For patients at high (risk of heart attack and stroke), this interaction is serious since these patients require aspirin to prevent" these cardiovascular problems.

Farkouh and associates investigated cardiovascular outcomes in high-risk patients with arthritis treated with ibuprofen, naproxen, or lumiracoxib. Their analyses were based on data for over 18,000 participants in the TARGET (Therapeutic Arthritis Research and Gastrointestinal Event Trial) study.

Among patients taking low-dose aspirin, the risk of death, heart attack, or stroke at 1 year was more common with ibuprofen than with lumiracoxib, the authors report, but did not differ significantly between naproxen and lumiracoxib.

Among patients not taking low-dose aspirin, there was no difference in outcomes between ibuprofen and lumiracoxib, the report indicates, but there were fewer cardiovascular events among those taking naproxen rather than lumiracoxib.

"For patients at high cardiovascular risk, naproxen is the drug of choice," Farkouh said. "It has the best overall safety record."

SOURCE: Annals of the Rheumatic Diseases, June 2007.

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