Overview

The objectives of this single site, randomized, crossover study is to evaluate the pharmacodynamic interactions between aspirin, NSAIDs and Coxibs with respect to platelet function, biomarkers of inflammation and endothelial function.

Eligibility

Inclusion Criteria:Qualified patients should have all 4 main criteria

1. Age 18-75 years of age for patients who regularly use NSAIDs.
2. Age 18-65 years of age for patients who do not regularly use NSAIDs
3. Able to give informed consent
4. Subjects with CVD or increased CV risk. Please see definitions for each criteria

   below

   • Increased CV risk (Subjects should have at least 3 of the following)
     • > 55 years of age
     • Hypertension
     • Dyslipidemia (LDL > 160 mg/dL or HDL < 40 mg/dL in females and < 35 mg/dL in males or subjects currently receiving lipid lowering therapy as standard of care (i.e. statin drugs, prescription ω 3-acid ethyl esters, fibrates or prescription niacin [≥1,000 mg/d])
     • Family history of premature CV disease (MI, angina pectoris, heart failure, cardiac death or coronary revascularization, stroke, carotid endarterectomy, or other arterial surgery or angioplasty for atherosclerotic vascular disease in a parent, grandparent, or sibling with symptom onset or diagnosis before age 55 y for males and 65 y for females)
     • Current smoker
     • Left ventricular hypertrophy
     • Documented ankle brachial index of <0.9
     • History of microalbuminuria, urine protein-creatinine ratio of >2
   • CV disease (defined as one of the following):
     • Calcium score of >0
     • ≥ 50 % occlusion of a coronary artery by angiography
     • ≥ 50 % occlusion of a carotid artery by angiography or ultrasound
     • History of stable angina
     • Symptomatic peripheral arterial disease
     • Prior MI, unstable angina, percutaneous coronary intervention, CABG, TIA, ischemic stroke, carotid endarterectomy, or other arterial surgery or angioplasty, which have occurred > 3 months prior to screening visit
     • Diabetes Mellitus type 1 or 2 (considered a CV disease equivalent).
   • Clinical diagnosis of rheumatoid arthritis, as determined by individual patient

     and physician, requiring daily treatment with NSAIDs.

        Exclusion Criteria: Subjects with any of the following criteria will be excluded from this
        study:
          1. Unstable angina, MI, CVA, CABG <3 months from screening visit
          2. Planned coronary, cerebrovascular, or peripheral revascularization
          3. Undergone major surgery within 3 months prior to screening visit or has planned major
             surgery during the study period
          4. Uncontrolled hypertension (SBP >190, DBP >100 mm Hg) during screening visit
          5. Uncontrolled arrhythmia < 3 months from screening visit
          6. NYHA class III-IV heart failure or if available, ejection fraction ≤ 35 %
          7. Within 6 months prior to screening visit, a history of ACS or hospitalization for
             heart failure
          8. Oral corticosteroid, prednisone (or equivalent) > 20 mg daily
          9. Anticoagulation therapy
         10. Antiplatelet therapy except for aspirin
         11. GI ulceration < 60 days before screening visit
         12. GI bleeding, perforation, obstruction < 6 months of screening visit
         13. Inflammatory bowel disease, diverticulitis active < 6 months of screening visit
         14. AST, ALT, or BUN >2x the upper limit normal (within 30 days prior to screening visit)
         15. Creatinine level >1.7 mg/dL in men, 1.5 mg/dL in women (within 30 days prior to
             screening visit)
         16. On fluconazole, methotrexate, or lithium therapy
         17. Malignancy < 5 years before screening visit
         18. Other known, active, significant GI, hepatic, renal, or coagulation disorders
         19. Allergy, allergic-type reactions or hypersensitivity (e.g. asthma, urticaria, etc.) to
             any of the study medications and its components (i.e. sulfonamides)
         20. History of any disease of condition that, in the opinion of the investigator would
             place the subject at an unacceptable risk to participate in this study
         21. Any clinically relevant abnormal findings in physical examination, vital signs, or
             previous laboratory works that, in the opinion of the investigator, may compromise the
             safety of the subject to participate
         22. Subjects who are legally institutionalized
         23. Lactating females or females of childbearing potential except for those who are
             surgically sterile or postmenopausal-