Paracetamol and Endothelial Function in Patients With Stable Coronary Artery Disease

Patients with chronic pain diseases (e.g. osteoarthritis) are dependent on effective medication. NSAIDs are very effective in lowering pain in these patients. Recently there has aroused major concern with regard to cardiovascular side effects and safety, especially in selective cyclooxygenase-2 inhibitors (coxibs) but also in "regular" NSAIDs.

At the moment, there is a big confusion, whether these drugs still should be used, especially in patients with known coronary artery disease. Physicians now try to switch to high dose paracetamol, despite the weaker efficacy in pain relieve, because this drug is considered generally as not harmful.

As there is very few information on the cardiovascular effect of this drug, we plan to perform this study and investigate the impact of paracetamol on endothelial function, an important cardiovascular surrogate marker, on inflammatory markers and on oxidative stress in patients with coronary artery disease on top of standard medication, including aspirin

Inclusion criteria

• Age: 30 - 80 years
• History of coronary artery disease (documented by coronary angiogram, nuclear imaging, positive stress test)
• Stable cardiovascular medication for at least 1 month
• Written obtained informed consent

Exclusion criteria

- myocardial infarction, unstable angina, stroke within 3 months prior to study entry

• coronary intervention/revascularisation procedure within 3 months prior to study entry
• Left ventricular ejection fraction <50%
• Other analgesics (Platelet inhibition therapy with Aspirin 100mg/d will be continued)
• Long acting nitrates
• Smoking
• Chronic heart failure (> NYHA II)
• Ventricular tachyarrhythmias
• Renal failure (serum creatinine >200umol)
• Liver disease (ALT or AST >100 IU), especially acute hepatitis
• Hyperbilirubinemia
• Alcohol abuse
• Oral Anticoagulation
• Concomitant therapy with Phenobarbital, Phenytoin, Carbamazepin, Isonicotinic Acid, Chloramphenicol Chlorzoxazone, Zidovudine, Salicylamide
• Insulin-dependent diabetes mellitus
• Drug abuse
• Anemia (Hb<10 g/dl)
• Known allergies on Paracetamol
• Pregnancy
• Malignancy (unless healed or remission > 5 years)
• Symptomatic hypotension, hypertension >160/100 mmHg
• Disease with systemic inflammation (e.g. rheumatoid arthritis, M. Crohn)
• Participation in another study within the last month