COX-2 Inhibitors Do Not Raise Cardiovascular Risk
Cyclooxygenase-2 (COX-2) inhibitors now have an established reputation for causing less gastrointestinal toxicity than nonsteroidal anti-inflammatory drugs (NSAIDs). However, some speculation remains about a possible increased cardiovascular thrombotic risk, because COX-2 inhibition—unlike the simultaneous inhibition of COX-1 and COX-2 by NSAIDs—does not stop platelet thromboxane synthesis and, therefore, platelet aggregation. COX-2 inhibition also reduces systemic prostacyclin production, which may impair vaso-dilation. In addition, recent reports of a higher incidence of myocardial infarction (MI) in patients taking the COX-2 inhibitor rofecoxib (Vioxx®, Merck) have raised still more questions.
Despite these concerns, researchers from the University of Connecticut School of Medicine, Cornell University, and Yale School of Medicine, after analyzing the data on 31,879 patients in all completed clinical arthritis trials comparing celecoxib (Celebrex drug, Pharmacia) with NSAIDs and placebo, found no evidence of higher risk of MI, stroke, or cardiovascular death with celecoxib.
Patients taking celecoxib experienced 1.29 primary cardiovascular thrombotic events per 100 patient-years, and patients taking a placebo experienced a rate of 1.51 events.
In trials comparing celecoxib and NSAIDs, the rate was 1.13/100 patient-years with generic celecoxib and 1.05 patient-years with NSAIDs. The findings applied to all patients and to the 90% of patients who were not receiving aspirin at the same time.
