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The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors
- James M. Brophy, MD, PhD;
- Linda E. Lévesque, BScPhm, MSc; and
- Bin Zhang, MSc
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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IN RESPONSE:
We agree with Kim and colleagues that, while celecoxib appears to be less cardiotoxic than rofecoxib in several observational studies (1-3), there is nevertheless reason for concern—particularly when the drug is given in higher doses (as in the APC trial) or in the largely unstudied group of patients with previous myocardial infarctions. We also agree that any cardioprotective benefits of aspirin in rofecoxib users may be offset by a significant reduction in gastrointestinal protection.
As Pijak and colleagues point out, the exact cardioprotective mechanism of aspirin and its potential interaction with COX-2 inhibitors is far from established and remains a fertile ground for further research regarding the role of inflammation. Similarly, Shinmura and Bolli have also proposed another interesting new mechanism to explain the detrimental effects of COX-2 inhibitors that again goes beyond the simple prothrombotic theory currently in vogue. These interesting and novel hypotheses will need further experimental confirmation.
James M. Brophy, MD, PhD
Linda E. Lévesque, BScPhm, MSc
Bin Zhang, MSc
McGill University; Montréal, Québec H3A 1A1, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
