与选择性COX-2抑制剂相关的心血管事件的风险
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
概括
选择性循环氧化酶2 (COX-2) 抑制剂可能会增加心血管事件的风险. 虽然一些研究显示没有差异,但另一些研究表明,这些关节炎药物导致心肌梗塞的发病率更高.
科学领域:
- 心血管医学 心血管医学
- 类风湿病学 类风湿病学
- 药理学 药理学 是一个学科.
背景情况:
- 动脉样硬化包括炎症;选择性循环氧化酶2 (COX-2) 抑制剂可以通过减少炎症提供抗动脉样效应.
- 然而,COX-2抑制剂可以降低前环素的产生,从而可能增加前血栓活性.
研究的目的:
- 在没有冠状动脉疾病的患者中评估COX-2抑制剂对心血管的影响,使用关节炎和肌肉骨疼痛药物.
- 评估COX-2抑制剂对血栓性心血管事件的安全性.
主要方法:
- 在MEDLINE上搜索有关COX-2抑制剂的英语文章 (1998年至2001年2月).
- 审查了制药公司向美国食品和药物管理局提交的文件.
- 分析了来自两个主要随机试验 (VIGOR,CLASS) 和两个较小试验的数据.
主要成果:
- 维格尔试验显示,与纳普罗森相比,罗菲科克西布与血栓性心血管事件的风险增加了2.38倍.
- 在CLASS试验中,塞莱科克西布和非类固醇抗炎药物之间心血管事件没有显著差异.
- 在一次性预防试验中,与安慰剂 (0.52%) 相比,罗菲科西布 (0.74%) 和赛莱科西布 (0.80%) 的年均心肌梗塞率显著更高.
结论:
- 现有数据表明,与COX-2抑制剂相关的心血管事件的风险可能会增加.
- 需要进一步的前性试验来充分描述和量化这种心血管风险.
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