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Dec. 7 tip sheet Annals of Internal Medicine

1. Different COX-2 Inhibitors Appear to Have Different Cardiovascular Effect

A study being released early online found that the COX-2 inhibitor rofecoxib (brand name Vioxx) had 2.72 higher odds for heart attack when compared with another COX-2 inhibitor, celecoxib (brand name Celebrex).

Rofecoxib was also associated with higher odds for heart attack compared with older NANSAIDs (non-selective non-aspirin non-steroidal anti-inflammatory drugs). It was not clear if use of celecoxib was associated with higher odds for heart attack than use of NANSAIDs.

NOTE: Reporters, editors: See schedule for PDF availability below.*)

The study examined patient reports of prior use of rofecoxib and celecoxib (two COX-2 inhibitor pain killers often used for arthritis pain) and NANSAIDs in a group of 1,718 people admitted to hospitals with a first, nonfatal myocardial infarction and a comparison group who did not have myocardial infarction.

They found that people who used the older over-the-counter NANSAIDs had a decreased risk for myocardial infarction compared to those who did not take NANSAIDs or one of the two COX-2 inhibitors. They found no overall class effect of COX-2 inhibitors for heart attack. The authors say "the study supports the hypothesis that different COX-2 inhibitors differ in their cardiovascular effects."

Writers in an accompanying editorial examine possible mechanisms by which NANSAIDs and COX-2 inhibitors reduce inflammation and may affect cardiovascular functioning.

They conclude that "further study is urgently needed to document the safety of COX-2 inhibitors."

In the meantime, they recommend that "physicians should avoid COX-2 inhibitors as a first line agent in patients with cardiovascular risk factors and average risk of gastrointestinal toxicity."

This article and the accompanying editorial will be available online at www.annals.org at 9 a.m. EST, Tuesday, December 7. Th
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Contact: Susan Anderson
sanderson@acponline.org
215-351-2653
American College of Physicians
6-Dec-2004


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