title: Channeling and prevalence of cardiovascular contraindications in users of cyclooxygenase 2 selective nonsteroidal antiinflammatory drugs.
abstract: OBJECTIVE
  To assess use and channeling of cyclooxygenase 2 selective inhibitors (coxibs) over time and to estimate the percentage of coxib users with cardiovascular contraindications.
  
  
  METHODS
  The study population comprised all coxib and nonselective nonsteroidal antiinflammatory drug (NSAID) users in the Integrated Primary Care Information project between January 2000 and December 2004. The prevalence of risk factors for NSAID-related upper gastrointestinal ulcer complications, cardiovascular disease, and cerebrovascular disease at the start of treatment was compared between users of coxibs and users of nonselective NSAIDs.
  
  
  RESULTS
  The study population included 72,841 nonselective NSAID users and 10,739 coxib users. The prevalence of risk factors for NSAID-related gastrointestinal complications was higher in coxib users than nonselective NSAID users (odds ratio [OR] 1.18, 95% confidence interval [95% CI] 1.10-1.26). Similarly, the prevalence of prior cardiovascular disease was higher in coxib users than in nonselective NSAID users (OR 1.35, 95% CI 1.28-1.43). Channeling of coxibs to patients with NSAID-related gastrointestinal risk factors declined after 2001 but increased again in 2004, whereas the channeling of coxibs to patients with cardiovascular disease remained constant. Less than 15% of all coxib users had history of ischemic coronary or cerebrovascular disease. Among coxib users with increased risk for NSAID-related gastrointestinal disorders, 27% had history of ischemic coronary or cerebrovascular disease.
  
  
  CONCLUSIONS
  This study demonstrates that coxibs were preferentially prescribed to patients with risk factors for NSAID-related gastrointestinal disorders and/or cardiovascular diseases. Only one-quarter of coxib users with increased risk for NSAID-related gastrointestinal complications had cardiovascular conditions compatible with recent European safety contraindications for coxibs.
authors.affiliation: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Georgio
authors.initials: G
authors.lastname: Mosis
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Jordi
authors.initials: J
authors.lastname: Castellsague
authors.forename: Jeanne P
authors.initials: JP
authors.lastname: Dieleman
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.forename: Bruno H C
authors.initials: BH
authors.lastname: Stricker
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology* / Q000235:genetics; D002648:Child; D015897:Comorbidity; D000075202:Contraindications; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D011336:Probability; D012109:Research Support as Topic; D018570:Risk Assessment
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors