"�Ibuprofen is relatively safe except when we give it with aspirin to people at high risk of heart attack," Farkouh says. "Only when given with aspirin do we see an excess of heart attacks." "

"Farkouh admits this is a controversial conclusion -- and that the study, which was not designed to look at ibuprofen safety, does not prove that ibuprofen is harmful to people at high risk of heart disease. "

"But he says the study provides a clear warning sign that ibuprofen is risky for people who need the blood-clot-reducing effect of daily low-dose aspirin. "

"�Those taking aspirin in the ibuprofen arm of the study had a ninefold excess of heart attacks," Farkouh says. "

"Steve Nissen, MD, chairman of cardiovascular medicine at The Cleveland Clinic and past president of the American College of Cardiology, urges caution. He notes that the findings are based on only eight heart attacks among thousands of high-risk patients taking ibuprofen and aspirin. "

"�The hazard ratio here is not relevant. It is not something I would trumpet," Nissen tells WebMD. �This is not to say Dr. Farkouh is not right. We have to be careful here. If we jump to conclusions, we may do more harm than good." "

"Farkouh says the numbers may be small but the potential risks are great. And it would not be the first time that relatively small numbers of heart attacks caused a major change in how doctors look at pain drugs. "

"�The whole Vioxx thing was based on 64 heart events among 21,000 patients studied," Farkouh says. "Here we are talking about potentially a higher magnitude of impact. The interaction of ibuprofen with aspirin is a bigger public health concern than Vioxx was." "

"Farkouh and colleagues report their findings in the early online issue of the BMJ specialty journal Annals of the Rheumatic Diseases. "

"The trial compared ibuprofen (brand names include Advil, Motrin, and Nuprin) or naproxen (Aleve, Naprosyn) to a new pain drug sold as Prexige in the U.K. and Canada. "

"Prexige is a member of the stomach-friendly family of pain drugs called Cox-2 inhibitors. Celebrex is the only member of this drug class sold in the U.S. Another Cox-2 drug, Vioxx, was taken off the market after people taking the drug had a suspiciously high number of heart attacks. "

"All of the high-heart-risk patients in the Farkouh study should have been taking low-dose aspirin. Sixty percent of them did. These patients should have had fewer heart attacks, strokes, and heart deaths than those who did not take aspirin. "

"But if the patients took aspirin and also took high-dose ibuprofen, they were nine times more likely to have a heart attack than were
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