S R J Maxwell1, R A Payne, G D Murray, D J Webb. 1. University of Edinburgh, Queen's Medical Research Institute, Royal Infirmary of Edinburgh and Public Health Sciences, University of Edinburgh Medical School, Edinburgh, UK. s.maxwell@ed.ac.uk
Abstract
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) with increased selectivity for the cyclooxygenase-2 (COX-2) isoform reduce gastrotoxicity but may increase adverse cardiovascular events. METHODS: We searched the literature for studies that reported the odds ratio (OR) for such events following exposure to NSAIDs. RESULTS: For studies comparing NSAID use with no use, increased COX-2 selectivity was significantly related to cardiovascular risk (log OR) amongst observational studies (R = -0.34, P < 0.001) and randomized controlled trials (RCTs) (R = -0.56, P < 0.001). For studies comparing NSAIDs, difference in selectivity was related to risk for observational studies (R = -0.28, P = 0.005) but not for RCTs (R = -0.23, P = 0.15). CONCLUSIONS: Although increased COX-2 selectivity may reduce gastrotoxicity, this may be at the cost of increasing cardiovascular risk.
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) with increased selectivity for the cyclooxygenase-2 (COX-2) isoform reduce gastrotoxicity but may increase adverse cardiovascular events. METHODS: We searched the literature for studies that reported the odds ratio (OR) for such events following exposure to NSAIDs. RESULTS: For studies comparing NSAID use with no use, increased COX-2 selectivity was significantly related to cardiovascular risk (log OR) amongst observational studies (R = -0.34, P < 0.001) and randomized controlled trials (RCTs) (R = -0.56, P < 0.001). For studies comparing NSAIDs, difference in selectivity was related to risk for observational studies (R = -0.28, P = 0.005) but not for RCTs (R = -0.23, P = 0.15). CONCLUSIONS: Although increased COX-2 selectivity may reduce gastrotoxicity, this may be at the cost of increasing cardiovascular risk.
Authors: Yan Cheng; Sandra C Austin; Bianca Rocca; Beverly H Koller; Thomas M Coffman; Tilo Grosser; John A Lawson; Garret A FitzGerald Journal: Science Date: 2002-04-19 Impact factor: 47.728
Authors: B F McAdam; F Catella-Lawson; I A Mardini; S Kapoor; J A Lawson; G A FitzGerald Journal: Proc Natl Acad Sci U S A Date: 1999-01-05 Impact factor: 11.205