Selectivity of NSAIDs for COX-2 and cardiovascular outcome.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) with increased selectivity for the cyclooxygenase-2 (COX-2) isoform reduce gastrotoxicity but may increase adverse cardiovascular events.


METHODS
We searched the literature for studies that reported the odds ratio (OR) for such events following exposure to NSAIDs.


RESULTS
For studies comparing NSAID use with no use, increased COX-2 selectivity was significantly related to cardiovascular risk (log OR) amongst observational studies (R = -0.34, P < 0.001) and randomized controlled trials (RCTs) (R = -0.56, P < 0.001). For studies comparing NSAIDs, difference in selectivity was related to risk for observational studies (R = -0.28, P = 0.005) but not for RCTs (R = -0.23, P = 0.15).


CONCLUSIONS
Although increased COX-2 selectivity may reduce gastrotoxicity, this may be at the cost of increasing cardiovascular risk.
Maxwell
S R J
SR
University of Edinburgh, Queen's Medical Research Institute, Royal Infirmary of Edinburgh and Public Health Sciences, University of Edinburgh Medical School, Edinburgh, UK. s.maxwell@ed.ac.uk
Payne
R A
RA
Murray
G D
GD
Webb
D J
DJ
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D006801:Humans; D012107:Research Design; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D051546:Cyclooxygenase 2