[Are there any differences in the cardiovascular tolerance between classical NSAIDs and coxibs?]

Area of Science:

• Pharmacology and Toxicology
• Cardiovascular Medicine
• Rheumatology

Background:

• Placebo-controlled studies indicate cardiovascular risks associated with specific NSAIDs like rofecoxib and celecoxib.
• Uncertainty exists regarding whether this cardiovascular toxicity is exclusive to coxibs or a broader class effect among NSAIDs.

Purpose of the Study:

• To investigate the cardiovascular and renal risks associated with both specific (coxibs) and non-specific NSAIDs.
• To compare the relative risks of different NSAIDs and identify factors influencing patient susceptibility.

Main Methods:

• Systematic review and meta-analysis of placebo-controlled studies, observational studies, and randomized trials.
• Comparative analysis of thrombotic cardiovascular events, arterial hypertension, edema, and congestive cardiac insufficiency across various NSAIDs.

Main Results:

• Meta-analyses suggest an increased risk of thrombotic cardiovascular accidents with rofecoxib and celecoxib compared to non-specific NSAIDs.
• Observational studies indicate increased risks for non-specific NSAIDs and, consistently, for rofecoxib, with some evidence for celecoxib.
• Rofecoxib demonstrated deleterious effects on cardiovascular and renal parameters compared to celecoxib and non-specific NSAIDs, while celecoxib showed no such effects in some comparisons.

Conclusions:

• All NSAIDs, regardless of specificity (coxibs or non-specific), appear to elevate cardiovascular and renal risks.
• The magnitude of risk varies among different NSAID compounds and is influenced by individual patient susceptibility and risk factors.
• Further long-term controlled studies are needed, but current data highlight a class-wide risk of cardiovascular side effects associated with NSAIDs.