 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Risk for Heart Attacks with Different NSAIDs
5 April 2005 | Volume 142 Issue 7 | Page I-45
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors: A Population Study of Elderly Adults." It is in the 5 April 2005 issue of Annals of Internal Medicine (volume 142, pages 481-489). The authors are L.E. Lévesque, J.M. Brophy, and B. Zhang.
What is the problem and what is known about it so far?
People commonly use nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain. Examples of NSAIDs include aspirin, etodolac (Lodine), ibuprofen (Advil or Motrin), and naproxen (Aleve). NSAIDs can irritate the lining of the stomach and cause ulcers and bleeding. Drugs called cyclooxygenase-2 (COX-2) inhibitors are a particular "selective" type of NSAID that may not injure the stomach lining as much as other NSAIDs. Examples of COX-2 inhibitors are celecoxib (Celebrex), meloxicam (Mobicox), rofecoxib (Vioxx), and valdecoxib (Bextra). Some COX-2 inhibitors may increase the risk for heart disease. For example, rofecoxib was withdrawn from the market in September 2004 because a large trial found that it increased the risk for heart attacks and strokes. We do not know whether other COX-2 inhibitors and nonselective NSAIDs have similar or different risks.
Why did the researchers do this particular study?
To see whether the risk for having a heart attack was similar among older adults taking selective and nonselective NSAIDs.
Who was studied?
113,927 adults older than 65 years of age in Québec, Canada.
How was the study done?
The researchers used administrative databases to identify older adults who were and were not receiving NSAIDs and who were and were not hospitalized for a first heart attack. They then compared the risk for having a heart attack between adults who had not received NSAIDs in the past year and those who were currently receiving NSAIDs. They examined 5 groups of NSAIDs: 3 selective COX-2 inhibitors (rofecoxib, celecoxib, meloxicam), 1 partially selective NSAID (naproxen), and traditional nonselective NSAIDs. They considered rofecoxib dosages greater than 25 mg daily to be high dose. They also examined whether concomitant aspirin use affected risks for heart attack among rofecoxib users.
What did the researchers find?
People prescribed rofecoxib had a 1.24 higher relative risk for heart attack compared to those prescribed no NSAIDs. Higher doses of rofecoxib were associated with higher risks. Concomitant aspirin use lessened the risks associated with low-dose, but not high-dose, rofecoxib. Celecoxib, meloxicam, and the other NSAIDs were not associated with increased risk for heart attack.
What were the limitations of the study?
The researchers did not assess over-the-counter use of aspirin and ibuprofen and whether people took prescribed amounts of NSAIDs. The researchers had limited ability to detect risks of meloxicam, naproxen, and traditional NSAIDs because most NSAID prescriptions were for rofecoxib and celecoxib. The researchers may have missed some heart attacks since the study databases recorded only heart attacks that led to hospitalization.
What are the implications of the study?
Some nonselective NSAIDs and COX-2 inhibitors, other than rofecoxib, might not increase the risk for a heart attack.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  E. Eruslanov, S. Kaliberov, I. Daurkin, L. Kaliberova, D. Buchsbaum, J. Vieweg, and S. Kusmartsev Altered Expression of 15-Hydroxyprostaglandin Dehydrogenase in Tumor-Infiltrated CD11b Myeloid Cells: A Mechanism for Immune Evasion in Cancer J. Immunol., June 15, 2009; 182(12): 7548 - 7557. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. John-Aryankalayil, S. T. Palayoor, D. Cerna, M. T. Falduto, S. R. Magnuson, and C. N. Coleman NS-398, ibuprofen, and cyclooxygenase-2 RNA interference produce significantly different gene expression profiles in prostate cancer cells Mol. Cancer Ther., January 1, 2009; 8(1): 261 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Solomon, J. Wittes, P. V. Finn, R. Fowler, J. Viner, M. M. Bertagnolli, N. Arber, B. Levin, C. L. Meinert, B. Martin, et al. Cardiovascular Risk of Celecoxib in 6 Randomized Placebo-Controlled Trials: The Cross Trial Safety Analysis Circulation, April 22, 2008; 117(16): 2104 - 2113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Hennekens and S. Borzak Cyclooxygenase-2 Inhibitors and Most Traditional Nonsteroidal Anti-inflammatory Drugs Cause Similar Moderately Increased Risks of Cardiovascular Disease Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2008; 13(1): 41 - 50. [Abstract] [PDF]
|
|
|
|
 |
|
 G. P. Joshi, R. Gertler, and R. Fricker Cardiovascular Thromboembolic Adverse Effects Associated with Cyclooxygenase-2 Selective Inhibitors and Nonselective Antiinflammatory Drugs Anesth. Analg., December 1, 2007; 105(6): 1793 - 1804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Kellogg, T. D. Wiggin, D. D. Larkin, J. M. Hayes, M. J. Stevens, and R. Pop-Busui Protective Effects of Cyclooxygenase-2 Gene Inactivation Against Peripheral Nerve Dysfunction and Intraepidermal Nerve Fiber Loss in Experimental Diabetes Diabetes, December 1, 2007; 56(12): 2997 - 3005. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P A Scott, G H Kingsley, C M Smith, E H Choy, and D L Scott Non-steroidal anti-inflammatory drugs and myocardial infarctions: comparative systematic review of evidence from observational studies and randomised controlled trials Ann Rheum Dis, October 1, 2007; 66(10): 1296 - 1304. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Klein, M. Eltze, T. Grebe, A. Hatzelmann, and M. Komhoff Celecoxib dilates guinea-pig coronaries and rat aortic rings and amplifies NO/cGMP signaling by PDE5 inhibition Cardiovasc Res, July 15, 2007; 75(2): 390 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Reuben, E. F. Ekman, and D. Charron Evaluating the Analgesic Efficacy of Administering Celecoxib as a Component of Multimodal Analgesia for Outpatient Anterior Cruciate Ligament Reconstruction Surgery Anesth. Analg., July 1, 2007; 105(1): 222 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C Waksman, A. Brody, and S. D Phillips Nonselective Nonsteroidal Antiinflammatory Drugs and Cardiovascular Risk: Are They Safe? Ann. Pharmacother., July 1, 2007; 41(7): 1163 - 1173. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Reuben and A. Buvanendran Preventing the Development of Chronic Pain After Orthopaedic Surgery with Preventive Multimodal Analgesic Techniques J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1343 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Madhok, O. Wu, G. McKellar, and G. Singh Non-steroidal anti-inflammatory drugs--changes in prescribing may be warranted Rheumatology, December 1, 2006; 45(12): 1458 - 1460. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Schneider, L. E. Levesque, B. Zhang, T. Hutchinson, and J. M. Brophy Association of Selective and Conventional Nonsteroidal Antiinflammatory Drugs with Acute Renal Failure: A Population-based, Nested Case-Control Analysis Am. J. Epidemiol., November 1, 2006; 164(9): 881 - 889. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. McGettigan and D. Henry Cardiovascular Risk and Inhibition of Cyclooxygenase: A Systematic Review of the Observational Studies of Selective and Nonselective Inhibitors of Cyclooxygenase 2 JAMA, October 4, 2006; 296(13): 1633 - 1644. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Chaiamnuay, J. J. Allison, and J. R. Curtis Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs. Am. J. Health Syst. Pharm., October 1, 2006; 63(19): 1837 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Cheng Use of Non-Aspirin Nonsteroidal Antiinflammatory Drugs and the Risk of Cardiovascular Events Ann. Pharmacother., October 1, 2006; 40(10): 1785 - 1796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Helin-Salmivaara, A. Virtanen, R. Vesalainen, J. M. Gronroos, T. Klaukka, J. E. Idanpaan-Heikkila, and R. Huupponen NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland Eur. Heart J., July 2, 2006; 27(14): 1657 - 1663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Rahme, Y. Toubouti, and E. Hunsche Therapy switching and associated costs in elderly patients receiving COX-2 selective inhibitors or non-selective non-steroidal anti-inflammatory drugs in Quebec, Canada Rheumatology, July 1, 2006; 45(7): 903 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Gislason, S. Jacobsen, J. N. Rasmussen, S. Rasmussen, P. Buch, J. Friberg, T. K. Schramm, S. Z. Abildstrom, L. Kober, M. Madsen, et al. Risk of Death or Reinfarction Associated With the Use of Selective Cyclooxygenase-2 Inhibitors and Nonselective Nonsteroidal Antiinflammatory Drugs After Acute Myocardial Infarction Circulation, June 27, 2006; 113(25): 2906 - 2913. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G.B. J. Mancini, M. Etminan, B. Zhang, L. E. Levesque, J. M. FitzGerald, and J. M. Brophy Reduction of Morbidity and Mortality by Statins, Angiotensin-Converting Enzyme Inhibitors, and Angiotensin Receptor Blockers in Patients With Chronic Obstructive Pulmonary Disease J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2554 - 2560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Armstrong Balancing the cyclooxygenase portfolio. Can. Med. Assoc. J., May 23, 2006; 174(11): 1581 - 1582. [Full Text] [PDF]
|
|
|
|
|
|
L. E. Levesque, J. M. Brophy, and B. Zhang Time variations in the risk of myocardial infarction among elderly users of COX-2 inhibitors Can. Med. Assoc. J., May 23, 2006; 174(11): 1563 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Andersohn, S. Suissa, and E. Garbe Use of First- and Second-Generation Cyclooxygenase-2-Selective Nonsteroidal Antiinflammatory Drugs and Risk of Acute Myocardial Infarction Circulation, April 25, 2006; 113(16): 1950 - 1957. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T. Chan, J. E. Manson, C. M. Albert, C. U. Chae, K. M. Rexrode, G. C. Curhan, E. B. Rimm, W. C. Willett, and C. S. Fuchs Nonsteroidal Antiinflammatory Drugs, Acetaminophen, and the Risk of Cardiovascular Events Circulation, March 28, 2006; 113(12): 1578 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Pijak, I. Huzicka, and F. Gazdik The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors Ann Intern Med, October 18, 2005; 143(8): 616 - 617. [Full Text] [PDF]
|
|
|
|
|
|
K. Shinmura and R. Bolli The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors Ann Intern Med, October 18, 2005; 143(8): 617 - 617. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Kim, Y. S. Choi, D. Yoon, and K. H. Cho The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors Ann Intern Med, October 18, 2005; 143(8): 615 - 616. [Full Text] [PDF]
|
|
|
|
|
|
M. R. Pijak, I. Huzicka, and F. Gazdik Coxibs and cardiovascular risk Can. Med. Assoc. J., October 11, 2005; 173(8): 852 - 852. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Fosslien Cardiovascular Complications of Non-Steroidal Anti-Inflammatory Drugs Ann. Clin. Lab. Sci., October 1, 2005; 35(4): 347 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. Jones and I. Power Editorial I: Postoperative NSAIDs and COX-2 inhibitors: cardiovascular risks and benefits Br. J. Anaesth., September 1, 2005; 95(3): 281 - 284. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman, D. DeMets, and J. Loscalzo Cyclooxygenase Inhibition and Cardiovascular Risk Circulation, August 2, 2005; 112(5): 759 - 770. [Full Text] [PDF]
|
|
|
|
|
|
S C. Jones Relative Thromboembolic Risks Associated with COX-2 Inhibitors Ann. Pharmacother., July 1, 2005; 39(7): 1249 - 1259. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Brophy, S. D. Solomon, J. Wittes, J. McMurray, the APC Study Cardiovascular Safety Committee and, B. M. Psaty, and C. D. Furberg Cardiovascular Risk Associated with Celecoxib N. Engl. J. Med., June 23, 2005; 352(25): 2648 - 2650. [Full Text] [PDF]
|
|
Read all Rapid Responses
