title: Coxibs Refocus Attention on the Cardiovascular Risks of Non-Aspirin NSAIDs.
abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) were differentiated from steroidal anti-inflammatory medicines to help clinicians who needed to use anti-inflammatory agents that were safer than steroids. With market entry of rofecoxib in 1999, NSAIDs were then further classified into traditional NSAIDs and cyclooxygenase (COX)-2 inhibitors (coxibs), the latter posing potentially fewer gastrointestinal risks. In 2005, rofecoxib was withdrawn from the market because of concerns about the risk of heart attack and stroke with long-term use, and clinical practice began focusing more on the cardiovascular versus gastrointestinal safety of coxibs. Since then, many coxibs have remained unapproved by the US FDA or have been removed from the market. This article explains how coxibs refocused attention on the cardiovascular safety of NSAIDs and the general implications of that. COX-2 activity/specificity is one factor associated with increased cardiovascular risks; however, these risks cannot be attributed to coxibs alone. The traditional NSAIDs (i.e., meloxicam, etodolac, and nabumetone) have significant COX-2 specificity, but naproxen and ibuprofen have less specificity. All NSAIDs, whether traditional or a coxib, pose some cardiovascular risks. It is possible that clinicians continue to focus more on decreasing the immediate gastric risks than preventing the later cardiovascular risks. The cardiovascular risks posed by NSAIDs should not be disregarded for the sake of achieving gastrointestinal benefits. Current recommendations suggest NSAIDs should be considered a single class of non-aspirin NSAIDs. Preferred NSAIDs are ibuprofen and naproxen. Coxibs are preferred in patients with low cardiovascular risk and high gastrointestinal risk who are intolerant to anti-dyspepsia therapy.
authors.affiliation: College of Pharmacy, Gulf Medical University, Post Box: 4184, Ajman, United Arab Emirates. dixon.thomas@gmail.com.
authors.forename: Dixon
authors.initials: D
authors.lastname: Thomas
authors.affiliation: College of Pharmacy, Gulf Medical University, Post Box: 4184, Ajman, United Arab Emirates.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Ali
authors.affiliation: College of Pharmacy, Gulf Medical University, Post Box: 4184, Ajman, United Arab Emirates.
authors.forename: Seeba
authors.initials: S
authors.lastname: Zachariah
authors.affiliation: College of Pharmacy, Gulf Medical University, Post Box: 4184, Ajman, United Arab Emirates.
authors.forename: Kishore Gnana Sam
authors.initials: KGS
authors.lastname: Sundararaj
authors.affiliation: Medical University of South Carolina Drug Information Center, Charleston, SC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Van Cuyk
authors.affiliation: Medical University of South Carolina Drug Information Center, Charleston, SC, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Cooper
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D002319:Cardiovascular System / Q000187:drug effects*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors
keywords: Celecoxib; Ibuprofen; Naproxen; Nimesulide; Rofecoxib