12/4/03 Selective COX-2 inhibitors and cardiovascular effectsSummaryThe use of selective inhibitors of the cyclooxygenase (COX)-2 pathway such as rofecoxib (Vioxx) or celecoxib (Celebrex) has increased greatly in recent years because of evidence that such agents are as effective as the less selective COX-1/COX-2 inhibitors (NSAID) in reducing musculoskeletal inflammation with less G-I side-effects than seen with the use of NSAID. The use of COX-2 inhibitors is particularly appealing in those with aspirin-triggered respiratory disease (Triad asthma) because such individuals usually tolerate these selective COX-2 inhibitors well but often experience worsened symptoms by ingestion of NSAID However, these COX-2 inhibitors do not decrease platelet aggregation or thromboxane synthesis while decreasing production of prostacyclin (an agent which decreases platelet aggregation). Therefore, concerns have been raised that individuals chronically treated with COX-2 inhibitors are at increased risk for platelet aggregation- associated adverse cardiovascular events (e.g. - myocardial infarct, stroke). This situation was reviewed by Weir et al of the Univ. of Maryland in Baltimore, MD. Based on their pooled analysis of findings in 23 studies involving over 14,000 patient years, they concluded that rofecoxib treatment was not associated with a significantly greater incidence of cardiovascular thrombotic events when compared with either placebo treatment or therapy with NSAID other than naproxen. It appears that naproxen, an NSAID with aspirin-like sustained inhibition of platelet aggregation, is associated with a particularly reduced incidence of thrombotic cardiovascular events. Reference Am Heart J. 2003; 146:591-604
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