Cardiovascular Effects of COX-2 Inhibitors: A Review of the Literature

When cyclooxygenase-2 (COX-2) inhibitors (coxibs) came on the market, they were expected to provide a treatment alternative to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) for patients who were at risk for gastrointestinal (GI) complications. For more than five years, coxibs have been prescribed to millions of patients for the treatment of arthritis, acute pain, Alzheimer’s disease, and cancer prevention. Until recently, a favored GI profile was the focus of this class of medications, when new data surfaced suggesting an increased risk of cardiovascular (CV) events in patients taking coxibs. In multiple trials and analyses, the incidence of CV events has been higher with coxibs than with placebo and other nonselective NSAIDs. With differences also reported between the individual coxibs, the question of a drug class effect has been raised. Although an explanation for these adverse effects has not yet been determined, several potential theories relate to physiological mechanisms, drug selectivity or structure, doses and duration of clinical trials, or the influence of underlying disease Cardiovascular Effects of COX-2 Inhibitors: A Review of the Literature