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How Super Are The "Super Aspirins"? -- New COX-2 Inhibitors May Elevate Cardiovascular Risk

A much-anticipated series of new drugs just coming to market promises to ease the pain of arthritis, menstrual cramps, headaches, and other afflictions equally as well as aspirin, ibuprofen, and related over-the-counter medications but without the sometimes serious side effects of those drugs. Stomach ulcers are among the worst of these side effects, leading to tens of thousands of hospitalizations and thousands of deaths annually.

A new study from the University of Pennsylvania Medical Center, however, raises the possibility of a downside to these so-called "super aspirins," or COX-2 inhibitors, one that could not have been detected in the clinical trials performed to date. The researchers looked closely at the pharmacology of the COX-2 inhibitors and discovered aspects of their action in the body that may elevate the risk of heart attacks, strokes, and other adverse cardiovascular events. A report on the study appears in the current issue of the Proceedings of the National Academy of Science, published January 5.

"The clinical trials designed to show that the COX-2 inhibitors work in treating arthritis have not shown evidence of a cardiovascular risk," says Garret A. FitzGerald, MD, chairman of the department of pharmacology and senior author on the study. "However, they would have been roughly an order of magnitude too small in their sample sizes to detect what we see as a possible problem associated with the use of these drugs. So, the question hangs out there for future experience: Will a cardiovascular risk emerge over time as the COX-2 inhibitors reach more and more patients?"

Aspirin and ibuprofen are members of a class of pain relievers known as nonsteroidal anti-inflammatory drugs, or NSAIDs. These drugs work by inhibiting an enzyme called cyclooxygenase, or COX. Scientists discovered early this decade that there are two forms of the enzyme, COX-1 and COX-2, and that the first, COX-1, protects the lining of t
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Contact: Franklin Hoke
hokef@mail.med.upenn.edu
215-349-5659
University of Pennsylvania School of Medicine
14-Jan-1999


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