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December 12, 2001

Cardiovascular Events and COX-2 Inhibitors

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(22):2808-2813. doi:10.1001/jama.286.22.2808

To the Editor: In their meta-analysis, Dr Mukherjee and colleagues1 found that cyclooxygenase 2 (COX-2) inhibitors might cause an increase in cardiovascular (CV) events. This may lead clinicians to avoid COX-2 inhibitors for their patients with arthritis. I believe that this conclusion is ill advised.

Other nonsteroidal anti-inflammatory drugs (NSAIDs) have been estimated to have a 1% to 4% annual rate of significant adverse events.2 The 2 large trials of COX-2 inhibitors, VIGOR (Vioxx Gastrointestinal Outcomes Research Study3) and CLASS (Celecoxib Arthritis Safety Study4), both found a 1% to 2% decline in serious gastrointestinal (GI) complications with the use of COX-2 inhibitors compared with other NSAIDs. In contrast, Mukherjee et al found a 0.24% and 0.3% increase in cardiovascular events for rofecoxib and celecoxib, respectively. Preventing about 3 CV events per thousand while increasing GI complications 10 to 20 per thousand may not be the most equitable trade.

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