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Selective COX-2 inhibitors, NSAIDs and cardiovascular events - is celecoxib the safest choice?

Laurence Guy Howes1

  • 1Departments of Cardiology, and Pharmacology and Therapeutics, Gold Coast Hospital, Griffith University Medical School Southport, Queensland, Australia.

Therapeutics and Clinical Risk Management
|May 14, 2008
PubMed

Insights

Cyclo-oxygenase (COX) inhibitors, including selective COX-2 drugs and non-selective NSAIDs, may increase cardiovascular event risk. Celecoxib shows relative safety at recommended arthritis doses compared to other COX inhibitors.

Area of Science:

  • Pharmacology and Therapeutics
  • Cardiovascular Medicine
  • Inflammation and Immunology

Background:

  • Cyclo-oxygenase (COX) inhibitors are common anti-inflammatory medications.
  • Concerns exist regarding the cardiovascular safety of COX inhibitors, including selective COX-2 inhibitors like rofecoxib and non-selective NSAIDs.
  • Previous studies linked rofecoxib to myocardial infarction, and other NSAIDs to serious cardiovascular events.

Purpose of the Study:

  • To review clinical trial and population data on the link between COX inhibition and cardiovascular events.
  • To assess the cardiovascular safety profile of different COX inhibitors.

Main Methods:

  • Review of existing clinical trial data.
  • Analysis of population-based studies investigating COX inhibitor use and cardiovascular outcomes.

Main Results:

  • Both selective COX-2 inhibitors and non-selective NSAIDs may elevate the risk of serious cardiovascular events.
  • Rofecoxib therapy demonstrates the strongest evidence for increased cardiovascular risk.
  • Celecoxib may increase cardiovascular risk only at doses significantly exceeding those recommended for arthritis treatment.

Conclusions:

  • The cardiovascular risk associated with COX inhibitors varies among individual drugs.
  • Evidence supports the relative cardiovascular safety of celecoxib at recommended arthritis treatment doses compared to other COX inhibitors and NSAIDs.
  • Further evaluation of cardiovascular risk profiles for all COX inhibitors is warranted.
Keywords:
COX-2 inhibitorsNSAIDscardiovascular diseasemyocardial infarction

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