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Coxibs, non-steroidal anti-inflammatory drugs and cardiovascular risk


Hermann, M; Ruschitzka, F (2006). Coxibs, non-steroidal anti-inflammatory drugs and cardiovascular risk. Internal Medicine Journal, 36(5):308-319.

Abstract

The introduction of selective cyclooxygenase-2 inhibitors offered the promise of similar efficacy in pain control without the gastrointestinal effects associated with non-selective non-steroidal anti-inflammatory drugs (NSAIDs). By blocking prostacyclin formation but leaving platelet-derived thromboxane A2 generation unopposed, there is concern that the potential gastrointestinal benefit of cyclooxygenase-2-selective inhibitors may come at the cost of increased thrombotic risk. However, the differential effects of coxibs on blood pressure, endothelial function, oxidative stress, tissue factor expression, vascular smooth muscle proliferation and neointimal hyperplasia indicate a distinct heterogeneity among this class of drugs. Importantly, the observation of an excess cardiovascular risk with traditional NSAIDs in randomized clinical trials, meta-analysis and large-scale observational studies further highlights the need to scrutinize the entire class of anti-inflammatory drugs, including traditional NSAIDs, as rigorously as coxibs.

The introduction of selective cyclooxygenase-2 inhibitors offered the promise of similar efficacy in pain control without the gastrointestinal effects associated with non-selective non-steroidal anti-inflammatory drugs (NSAIDs). By blocking prostacyclin formation but leaving platelet-derived thromboxane A2 generation unopposed, there is concern that the potential gastrointestinal benefit of cyclooxygenase-2-selective inhibitors may come at the cost of increased thrombotic risk. However, the differential effects of coxibs on blood pressure, endothelial function, oxidative stress, tissue factor expression, vascular smooth muscle proliferation and neointimal hyperplasia indicate a distinct heterogeneity among this class of drugs. Importantly, the observation of an excess cardiovascular risk with traditional NSAIDs in randomized clinical trials, meta-analysis and large-scale observational studies further highlights the need to scrutinize the entire class of anti-inflammatory drugs, including traditional NSAIDs, as rigorously as coxibs.

Citations

21 citations in Web of Science®
23 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2006
Deposited On:11 Feb 2011 15:00
Last Modified:05 Apr 2016 14:17
Publisher:Wiley-Blackwell
ISSN:1444-0903
Publisher DOI:10.1111/j.1445-5994.2006.01056.x
PubMed ID:16650206

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