選択的COX-2阻害剤と関連した心血管疾患のリスク
D Mukherjee1, S E Nissen, E J Topol
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, F 25, 9500 Euclid Ave, Cleveland, OH 44195, USA.
JAMA
|August 31, 2001
まとめ
選択性サイクロオキシゲナーゼ2 (COX-2) 阻害剤は,心血管疾患のリスクを増やす可能性があります. いくつかの研究は違いを示さないが,他の研究はこれらの関節炎薬で心筋梗塞のより高い割合を示している.
科学分野:
- 心血管医学は,心血管医学である.
- レウマトロジーの病理学
- 薬理学 薬理学とは
背景:
- 動脈硬化症は炎症を伴う;選択性サイクロオキシゲナーゼ2 (COX-2) 阻害剤は,炎症を軽減することにより,抗動脈縮効果を提供することができる.
- しかし,COX-2阻害剤は,プロスタサイクリン生成を低下させ,プロトロンボティック活性を増やす可能性があります.
研究 の 目的:
- 冠動脈疾患のない患者におけるCOX-2阻害剤の心血管効果を評価するために,関節炎および筋骨格の痛み薬を使用する.
- 血栓性心血管疾患に関するCOX-2阻害剤の安全性を評価する.
主な方法:
- COX-2阻害剤に関する英語の記事をMEDLINEで検索しました (1998年 - 2001年2月).
- 米国食品医薬品局に提出した製薬会社の提出書をレビューした.
- 2つの主要なランダム化試験 (VIGOR,CLASS) と2つの小規模試験のデータを分析した.
主要な成果:
- VIGOR試験では,ナプロクセンと比較して,ロフェコキシブによる血栓性心血管疾患のリスクが2.38倍増加することが示されました.
- CLASS試験では,セレコキシブと非ステロイド性抗炎症剤の間で心血管疾患の有意な差は認められなかった.
- 1年あたりの心筋梗塞の発生率は,ロフェコキシブ (0.74%) とセレコキシブ (0.80%) とともに,プラセボ (0.52%) と比較して,一次予防試験で著しく高かった.
結論:
- 入手可能なデータは,COX-2阻害剤と関連した心血管疾患のリスクの増加の可能性を示唆しています.
- この心血管疾患のリスクを完全に特徴づけ,定量化するために,さらなる前向きな試験が必要である.
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