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Ibuprofen May Abrogate the Benefits of Aspirin When Used for Secondary Prevention of Myocardial Infarction
MARIE HUDSON, MURRAY BARON, ELHAM RAHME, and LOUISE PILOTE
ABSTRACT. Methods. In this population based, retrospective cohort study using governmental databases, patients ≥ 66 years of age, hospitalized for an index acute myocardial infarction (AMI) between January 1992 and March 1999 and taking ASA throughout the period of followup were identified. The main exposure was the concomitant use of ibuprofen and ASA after the index AMI. The outcome of interest was recurrent AMI. Subjects were followed to one year after the index AMI. Results. A total of 18,503 patients met the study entry criteria. Of these, 372 patients were dispensed a prescription for ibuprofen (exposed) and 14,424 patients were not dispensed a prescription for any nonsteroidal antiinflammatory drug (NSAID) (unexposed). Patients dispensed prescriptions for any NSAID (n = 4079), naproxen (n = 1239), and diclofenac (n = 1474) were analyzed separately. There was a trend to an increase in the rate of recurrent AMI in patients taking ibuprofen and ASA compared to those taking ASA alone as the duration of exposure increased [hazard ratios for ever, ≥ 30 days, and ≥ 60 days exposed were 1.01 (95% CI 0.58–1.76), 1.13 (95% CI 0.54–2.39), and 1.83 (95% CI 0.76–4.42), respectively]. In contrast, subjects taking prolonged naproxen and ASA had a trend toward a lower rate of recurrent AMI compared to those taking ASA alone. Conclusion. The results are consistent with data that suggest that regular, but not intermittent, ibuprofen may abrogate the benefits of aspirin when used for the secondary prevention of AMI. There may be differences in the risk of heart disease with various NSAID. (J Rheumatol 2005;32:1589-93) Key Indexing Terms:
IBUPROFEN
From the Division of Clinical Epidemiology, McGill University Health Centre, Montreal; and Division of Rheumatology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. Supported in part by grant 53181 from the Canadian Institutes for Health Research. Dr. Hudson, Dr. Rahme, and Dr. Pilote are supported by the Canadian Institutes of Health Research. Dr. Hudson and Dr. Rahme are also funded by The Arthritis Society. Dr Rahme has served as a consultant for Pfizer Inc. and Merck & Co. Inc., in relation to other studies. M. Hudson, MD, MPH; E. Rahme, PhD, McGill University Health Centre; L. Pilote, MD, MPH, PhD, William Dawson Professor of Medicine, McGill University, McGill University Health Centre; M. Baron, MD, Sir Mortimer B. Davis Jewish General Hospital. Address reprint requests to Dr. L. Pilote, Division of Clinical Epidemiology, L-10 421, The Research Institute of the McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4. E-mail: louise.pilote@mcgill.ca Accepted for publication March 29, 2005. |