The cardiovascular safety of cyclooxygenase ( COX )-2–selective nonsteroidal antiinflammatory drugs ( NSAIDs ) has come under scrutiny after the withdrawal of Rofecoxib ( Vioxx ) and halting of the Adenoma Prevention with Celecoxib ( Celebrex ) trial.

It is unknown whether the newer second-generation COX-2 inhibitors ( Etoricoxib/Arcoxia, Valdecoxib/Bextra ) also increase the cardiovascular risk.

Researchers at Charité–Universitaetsmedizin Berlin, Berlin ( Germany ) and McGill University Health Centre, Montreal ( Canada ), performed a nested case-control study in a cohort of 486 378 persons registered within the United Kingdom General Practice Research Database with at least 1 prescription of an NSAID between June 1, 2000, and October 31, 2004.

A total of 3643 cases with acute myocardial infarction ( AMI ) were matched to 13 918 controls.

Current use of Etoricoxib was associated with a 2.09-fold risk of acute myocardial infarction compared with no use of NSAIDs during the prior year.
Current use of Rofecoxib ( RR=1.29 ), Celecoxib ( RR=1.56 ), and Diclofenac ( RR=1.37 ) also significantly increased the AMI risk.
For current use of Valdecoxib, the RR was 4.60.

Rate ratios appeared to increase with higher daily doses of COX-2 inhibitors and were also increased in patients without major cardiovascular risk factors.

According to authors, the study supports the hypothesis that the elevated risk of acute myocardial infarction is a class effect of COX-2 inhibitors.

Source: Circulation, 2006


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