Risk of cardiovascular events associated with selective COX-2 inhibitors.

@article{Mukherjee2001RiskOC,
  title={Risk of cardiovascular events associated with selective COX-2 inhibitors.},
  author={D Mukherjee and Steven E. Nissen and Eric J. Topol},
  journal={JAMA},
  year={2001},
  volume={286 8},
  pages={
          954-9
        }
}
Atherosclerosis is a process with inflammatory features and selective cyclooxygenase 2 (COX-2) inhibitors may potentially have antiatherogenic effects by virtue of inhibiting inflammation. However, by decreasing vasodilatory and antiaggregatory prostacyclin production, COX-2 antagonists may lead to increased prothrombotic activity. To define the cardiovascular effects of COX-2 inhibitors when used for arthritis and musculoskeletal pain in patients without coronary artery disease, we performed a… 

Figures and Tables from this paper

Selective COX-2 Inhibition Improves Endothelial Function in Coronary Artery Disease

This is the first study to demonstrate that selective COX-2 inhibition improves endothelium-dependent vasodilation and reduces low-grade chronic inflammation and oxidative stress in coronary artery disease and holds the potential to beneficially impact outcome in patients with cardiovascular disease.

Selective COX-2 Inhibitors and Risk of Cardiovascular Events

This review article discusses the implications of the CLASS and VIGOR studies and analyzes other studies that examine the association between NSAIDs and MIs as well as other acute thromboembolic events.

Cyclooxygenase-2 Inhibition and Coagulation

The effect of COX-2 inhibition on the coagulation system is reviewed; the molecular mechanisms involved are discussed and important clinical trials in which an increased frequency of thrombotic complications coxibs was observed are summarized.

Cardiovascular hazard of selective COX-2 inhibitors: myth or reality?

The authors’ analysis shows that even though there are pathophysiological mechanisms which could explain why selective COX-2 inhibition might increase the cardiovascular risk in patients, the actual level of evidence demonstrating that the risk is indeed increased is weak.

Cardiovascular effects of the selective cyclooxygenase-2 inhibitors.

  • W. White
  • Medicine
    Sub-cellular biochemistry
  • 2007
Factors to consider include the interference of certain NSAIDs, such as ibuprofen or naproxen, with the antiplatelet effects of aspirin; direct effects of non-selective NSAIDs and of COX-2 selective inhibitors on fluid retention and blood pressure; emerging data about cardiovascular risks associated with these drugs.

Cyclooxygenase-2 inhibitors: Is there an association with coronary or renal events?

  • R. Bing
  • Medicine, Biology
    Current atherosclerosis reports
  • 2003
It was concluded from both clinical and experimental findings that COX-2 inhibitors can cause thrombotic cardiovascular events as well as renal disease and care should be exercised in administering specific COX -2 inhibitors to patients with pre-existing cardiac or renal disease.

Understanding the NSAID related risk of vascular events

This review links biochemical facts concerning NSAIDs and COX inhibitors with data from clinical trials to show that a class effect might exist for selective COX 2 inhibitors.

Nonsteroidal anti-Inflammatory drugs and cardiovascular risk.

...

References

SHOWING 1-10 OF 46 REFERENCES

Outcome of specific COX-2 inhibition in rheumatoid arthritis.

Celecoxib provides significant improvement in patient global assessment, morning stiffness, and the number of painful and tender joints compared with placebo and specific COX-2 inhibition with celecoxib causessignificant improvement in the signs and symptoms of RA.

Gastrointestinal tolerability of the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib compared with nonselective COX-1 and COX-2 inhibitors in osteoarthritis.

Rofecoxib was associated with a higher incidence of treatment discontinuations due to GI AEs over 12 months and a lower incidence of dyspeptic-type GI AE over 6 months than treatment with nonselective COX inhibitors, or NSAIDs.

Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study.

In this study, celecoxib, at dosages greater than those indicated clinically, was associated with a lower incidence of symptomatic ulcers and ulcer complications combined, as well as other clinically important toxic effects, compared with NSAIDs at standard dosages.

The Cyclooxygenase-2 Inhibitors: Safety and Effectiveness

Preliminary data indicate that the selective COX-2 inhibitors provide analgesic and antiinflammatory efficacy comparable with older NSAIDs, with fewer adverse gastrointestinal effects.

Anti-inflammatory drugs and their mechanism of action

Selective COX-2 inhibitors may demonstrate new important therapeutic benefits as anticancer agents, as well as in preventing premature labor and perhaps even retarding the progression of Alzheimer's disease.

Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics, and vasoactive eicosanoids.

The data suggest that acute sodium retention by nonsteroidal anti-inflammatory drugs in healthy elderly subjects is mediated by the inhibition of Cox-2, whereas depression of GFR is due to inhibition ofcox-1.

Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor

The incidence of UGI ulcer complications associated with celecoxib was 8-fold lower than with nonspecific, nonsteroidal anti-inflammatory drugs (NSAIDs), and that in non-NSAID users reported in the literature was similar to that in patients receiving placebo in the RCTs.

Inflammation and Coronary Heart Disease: An Overview

  • W. Koenig
  • Medicine, Biology
    Cardiology in review
  • 2001
The pathogenesis of atherosclerosis, the role of endothelial dysfunction and plaque rupture, and evidence for the roles of inflammation are discussed and how therapy might reduce vascular inflammation is reviewed.

Cyclooxygenase-1 and -2-dependent prostacyclin formation in patients with atherosclerosis.

Both COX-1 and -2 are expressed and contribute to the increase in PGI( 2) in patients with atherosclerosis, whereas TXA(2) is generated by COX -1.

Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients.

Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.