[Cardiovascular risk of cyclooxygenase selective inhibitors]

It has been estimated that 30 million people worldwide take an nonsteroidal antiinflammatory drug (NSAID) daily. The main clinical objectives of these drugs are both to reduce joint pain and to improve joint function. However, gastrointestinal adverse events lead to the development of cyclooxygenase selective inhibitors (COXIB) with a better gastrointestinal safety profile. Since 1999, COXIB shown capacity to develop cardiovascular adverse events. Subsequent discoveries confirm overall risk of cardiovascular events. The increased cardiovascular risk occurred both in patients who were taking aspirin and in those who were not. Similar results with different COXIB appears to be a class effect of the COX-2 inhibitors, so patient risk factors must be identified and used in treatment decision making. Patients with gastrointestinal risk factors and no cardiovascular risk may benefit from use of a gastroprotective agent plus a nonselective nonsteroidal antiinflammatory drugs as a COXIB. We review assays whose objective was to study cardiovascular security of nonsteroidal antiinflammatory drugs and COXIB for known advantages and limitations of these drugs.