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[Are there any differences in the cardiovascular tolerance between classical NSAIDs and coxibs?]
Jean-Pierre Valat1, Gilbert Deray, François Héloire
1Université François Rabelais, Faculté de Médecine, Tours.
Presse Medicale (Paris, France : 1983)
|December 6, 2007
Summary
All non-steroidal anti-inflammatory drugs (NSAID), including coxibs, increase cardiovascular and renal risk. This risk varies by drug and patient factors, necessitating individualized assessment for safe NSAID use.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Drug Safety
Context:
- Cardiovascular (CV) risks associated with specific NSAIDs (coxibs) like rofecoxib and celecoxib are established.
- Uncertainty exists regarding whether this CV toxicity is exclusive to coxibs or a broader class effect among all NSAIDs.
Purpose:
- To synthesize evidence comparing the CV and renal risks of specific NSAIDs (coxibs) versus non-specific NSAIDs.
- To evaluate the comparative safety profiles of different NSAID compounds regarding thrombotic events, hypertension, edema, and heart failure.
Summary:
- Multiple meta-analyses and observational studies indicate that both coxibs and non-specific NSAIDs are associated with an increased risk of thrombotic CV events.
- Rofecoxib consistently shows a higher risk compared to celecoxib and non-specific NSAIDs across various CV outcomes.
- While celecoxib shows some increased risk in certain studies, evidence suggests NSAIDs, in general, elevate CV and renal risk, with variability between compounds.
Impact:
- Findings suggest a class-wide CV and renal risk associated with NSAIDs, necessitating careful patient selection and risk factor evaluation.
- Individualized risk assessment is crucial, considering patient susceptibility and specific drug properties.
- The data underscore the need for ongoing research and long-term controlled studies to fully elucidate NSAID-related CV risks.
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