Rofecoxib but not other coxibs tied to cardiovascular risks

Last Updated: 2006-06-02 13:11:14 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Alone among selective cyclo-oxygenase 2 inhibitors (coxibs) and non-steroidal anti-inflammatory drugs (NSAIDs) evaluated in a new study, rofecoxib (Vioxx) use was significantly associated with an increased rate of cardiovascular events.

Moreover, lead investigator Dr. Daniel H. Solomon told Reuters Health, "Our findings suggest that the cardiovascular risk associated with rofecoxib begins immediately and persists throughout the period of use. No other agents were found to be associated with risk."

To shed further light on the cardiovascular risks that may be associated with use of coxibs and NSAIDS, Dr. Solomon of Brigham and Women's Hospital, Boston and colleagues studied data on about 100,000 Medicare beneficiaries. Almost 75% had started use of a coxib or NSAID after the beginning of 1999. The remaining subjects were comparable users of other drugs and acted as a reference group.

Reporting in the May issue of Arthritis and Rheumatism, the researchers found that there was a significant elevation in the rate of myocardial infarction or ischemic stroke in users of rofecoxib (relative risk 1.15). This was seen within 60 days and persisted throughout 3 years. The pattern appeared similar in patients at high and low baseline cardiovascular risk.

There was significant reduction in risk with use of naproxen (relative risk 0.75), but no other coxib or NSAID was associated with a significant increase or decrease in cardiovascular event rate.

"This study was undertaken to assess the time course of cardiovascular risk in patients who use an NSAID or coxib." Dr. Solomon pointed out.

"These results," he concluded, "should give patients and doctors confidence that at typical dosages used in practice, most of these agents are not associated with excess cardiovascular risk."

Arthritis Rheum 2006;54:1378-1389.