Jeong A. Kim, MD, PhD; Youn Seon Choi, MD, PhD; Dokyung Yoon, MD, PhD; Kyung Hwan Cho, MD, PhD
Potential Financial Conflicts of Interest: None disclosed.
Kim JA, Choi YS, Yoon D, Cho KH. The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors. Ann Intern Med. 2005;143:615-616. doi: 10.7326/0003-4819-143-8-200510180-00020
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Published: Ann Intern Med. 2005;143(8):615-616.
TO THE EDITOR:
Lévesque and colleagues (1) reported that myocardial infarction risk was not increased with celecoxib. One recent study, Prevention of Spontaneous Adenomatous Polyps (PreSAP) (2), also showed that celecoxib does not increase the risk for cardiovascular events. However, we should consider the result of the Adenoma Prevention with Celebrex (APC) trial (3). In the APC trial, celecoxib use was associated with a dose-related increase in serious cardiovascular events; the authors concluded that this observation supported the hypothesis that sustained inhibition of prostacyclin with cyclooxygenase-2 (COX-2) inhibitors in twice-daily doses may increase cardiovascular risk compared with the once-daily doses given in the PreSAP study. Therefore, we should not easily conclude that celecoxib is unrelated to cardiovascular complications even though the risk may be lower than the risk associated with rofecoxib. Furthermore, we should give as much consideration to the dosing schedule as we give to the size of the dose. This study also stated that only 25% of current users of celecoxib received doses greater than 200 mg per day. However, for prevention of adenomatous polyposis, higher doses need to be considered. So, the effects of high-dose celecoxib and its associated complications should not be disregarded.
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