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
Contact: Susan Anderson
American College of Physicians