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COX-2 inhibitors may not be heart healthy

CLEVELAND, OHIO. COX-2 inhibitors have had a rapid rise to fame. They were introduced in 1999 and by October 2000 annual sales exceeded $3 billion in the United States corresponding to about 100 million individual prescriptions. The COX-2 class drugs, celecoxib (Celebrex) and rofecoxib (Vioxx), are mainly used in the treatment of rheumatoid arthritis, but have also been prescribed for general pain relief. They are less likely to promote internal bleeding and stomach ulcers than are aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs).

Researchers at the Cleveland Clinic now warn that the COX-2 inhibitors may not be as benign as originally thought. An extensive literature review turned up the finding that the risk of having a heart attack while on rofecoxib is 42 per cent greater than if taking a placebo (0.74 per cent versus 0.52 per cent annual rate). The same applied to celecoxib where the risk is 54 per cent greater (0.80 per cent versus 0.52 per cent annual rate). The data was extracted from trials involving 23,407 patients. Another trial found that people taking rofecoxib had twice as many cardiovascular events (heart attacks, strokes, angina, etc.) than did patients on the NSAID naproxen. The Cleveland researchers call for large-scale clinical trials to verify or refute their findings, but in the meantime urge caution in prescribing COX-2 inhibitors to people at risk for heart disease.
Mukherjee, Debabrata, et al. Risk of cardiovascular events associated with selective COX-2 inhibitors. Journal of the American Medical Association, Vol. 286, August 22/29, 2001, pp. 954-59

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