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The Medicine Cabinet Some Painkillers Can Help Prevent
Alzheimer’s, Heart Disease

Commentary By Dr. Timothy Johnson


B O S T O N, Jan. 23 — Several recent studies have raised some
new questions about the use of some over-the-counter pain and fever
medications for the long-term prevention of heart disease and
Alzheimer's.

The drugs in question are part of a group known as NSAIDs (pronounced
EN-seds) —Non-Steroidal Anti-Inflammatory Drugs. NSAIDs are
effective against inflammation — like steroids such as
prednisone — but are much safer for regular use than steroids.

The NSAID group includes aspirin, ibuprofen
(marketed under the names Motrin and Advil) and naproxen (Aleve). It
does not include acetaminophen (Tylenol), which is effective against
pain and fever but not against inflammation — which is a major
factor in certain types of pain, such as the ache of rheumatoid
arthritis.

So, can NSAIDs really help protect against chronic illnesses? Well,
let's address this by looking at the four most common questions that
I get about these drugs, and at some of the recent reports concerning
them.

Do all of these drugs protect against heart disease like aspirin?

The answer is an important "no." Aspirin is the only one that offers
strong protection against heart disease by interfering with blood
clot formation and probably acting in other ways we do not
understand.

What about recent reports that these drugs may reduce the risk for
Alzheimer's disease?

The most dramatic of these reports was a recent Dutch study that
suggested that regular and long-term (at least two years) use of some
NSAIDs like ibuprofen could reduce the risk of Alzheimer's by as much
as 80 percent. However, before recommending that people take NSAIDs
for this purpose, I believe we need more precisely done studies.

What about recent reports that taking ibuprofen and aspirin at the
same time could interfere with the protective effect of aspirin on
the heart?

This study, published in the Dec. 20 issue of the New England Journal
of Medicine, is actually quite complicated. For example, it
demonstrated that if a baby aspirin was taken two hours before two
tablets of ibuprofen, the protective effect of aspirin — at
least in the laboratory ****ysis was basically unaffected.

However, if the ibuprofen was taken before the aspirin, the impact on
the protective effect of the aspirin was considerable. Once again, we
have a lot more to learn about this possible interaction before
making any firm recommendations.

Most experts believe an occasional ibuprofen for, say, a headache
should not significantly interfere with the heart protective effect
of regular aspirin.

There are many other questions to consider in using these drugs
— such as cost and safety. All NSAIDs (including aspirin, of
course) can increase the risk for ulcers and bleeding in the
gastro-intestinal system, though some newer ones available by
prescription (such as Celebrex and Vioxx) are less likely to do so.
However, for most people, the much lower cost of older NSAIDs like
aspirin, Motrin, Advil and Aleve will make them the drugs of choice.

http://abcnews.go.com/sections/living/DailyNews/drjohnson_NSAIDs_020124.html