Michael Stanley, a heart patient with high blood pressure, stopped taking the aspirin, ACE-inhibitor combination

March 10, 1999
Web posted at: 4:36 p.m. EST (2136 GMT)

In this story: Death rate more than doubles when patients take both drugs Expert reaction: Findings may be premature RELATED STORIES, SITES

NEW ORLEANS (CNN) -- A cardiologist from the Cleveland Clinic Foundation reported that millions of Americans who take both aspirin and a popular blood pressure drug each day may be at a greater risk of suffering a heart attack than previously believed.

Dr. Eric Topol, a leading heart researcher, presented his findings at this week's American College of Cardiology meeting in New Orleans. His analysis indicated that when aspirin and an ACE-inhibitor drug are taken together, they may cancel each other out, rendering each drug ineffective.

Topol recommended that heart patients discuss the drugs' interactions with their doctors, and not make any sudden changes in their prescriptions without a physician's advice.

His findings come from examining medical records for thousands of heart patients in two separate studies.

Many doctors prescribe an aspirin-a-day for their heart patients. Many patients also take an ACE (angiotensin-converting enzyme) inhibitor, the most commonly-prescribed class of drugs for hypertension.

However for his own patients, such as disc jockey Michael Stanley who suffered a heart attack over the holidays, Topol now prescribes alternative medications.

Death rate more than doubles when patients take both drugs

Topol said, "We have two large trial databases where we've seen either a two-and-a-half or three-fold increase in the death rate for the aspirin and ACE-inhibitor combination."

Topol and his colleagues first examined the largest study ever of heart attack patients, the GUSTO Study of 18,307 heart patients. Topol's team calculated a two-and-a-half-fold increase in heart deaths for patients on both aspirin and ACE inhibitors.

"We said, well, this might be a fluke, we need to look at another trial database to verify this very worrisome finding and we did that," he added.

Topol's team then looked at 1,222 patients in the EPILOG Angioplasty Study and found a three-fold increase in deaths for patients who took the two-drug combination.

Expert reaction: Findings may be premature

University of Michigan cardiologist Bertram Pitt said this is not the time to pull patients off the two drugs. "We don't have any clear evidence there is a bad effect. There is conflicting data and I think patients should rely on the best advice of their doctors," he said.

Dr. Eliav Barr, director of clinical research at Merck Research Laboratories, said the studies done to date have been inconclusive. Merck makes Vasotec, the top-selling ACE inhibitor.

And from the U.S. Food and Drug Administration, the agency charged with approving and monitoring the safety of prescription drugs in the U.S., the only comment recently was a call for further study.

However, an expert on ACE inhibitors with the FDA told CNN: "There has been a lot of informed speculation about the possibility that aspirin may reduce the efficiency of ACE inhibitors. We really do need a large-scale, properly randomized trial to resolve this issue."

CNN Medical Correspondent Rhonda Rowland contributed to this report.