The coxibs and traditional nonsteroidal anti-inflammatory drugs: a current perspective on cardiovascular risks

There is strong evidence from randomized clinical trials that the highly selective cox-2 inhibitors (coxibs), compared with placebo, cause an excess of serious cardiovascular events that are not mitigated by low-dose acetylsalicylic acid. Both Health Canada and the Food and Drug Administration have concluded that the excess cardiovascular events may be a 'class effect' of all the nonsteroidal anti-inflammatory drugs (NSAIDs), including traditional NSAIDs (tNSAIDs) and coxibs, and now require appropriate black box labelling of all these agents. Celecoxib and lumiracoxib are the only coxibs remaining on the market in Canada. The prostanoid pathways, the roles of cox-1 and cox-2, as well as the inhibitory effects of acetylsalicylic acid, traditional tNSAIDs and the coxibs, are briefly reviewed. Current recommendations for the ongoing use of coxibs and the tNSAIDs are summarized.