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Letters |18 October 2005

The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors

James M. Brophy, MD, PhD; Linda E. Lévesque, BScPhm, MSc; Bin Zhang, MSc

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Author, Article, and Disclosure Information
  • From McGill University, Montréal, Québec H3A 1A1, Canada.

    Potential Financial Conflicts of Interest: None disclosed.

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We agree with Kim and colleagues that, while celecoxib appears to be less cardiotoxic than rofecoxib in several observational studies (1-3), there is nevertheless reason for concern—particularly when the drug is given in higher doses (as in the APC trial) or in the largely unstudied group of patients with previous myocardial infarctions. We also agree that any cardioprotective benefits of aspirin in rofecoxib users may be offset by a significant reduction in gastrointestinal protection.
As Pijak and colleagues point out, the exact cardioprotective mechanism of aspirin and its potential interaction with COX-2 inhibitors is far from established and remains a fertile ground for further research regarding the role of inflammation. Similarly, Shinmura and Bolli have also proposed another interesting new mechanism to explain the detrimental effects of COX-2 inhibitors that again goes beyond the simple prothrombotic theory currently in vogue. These interesting and novel hypotheses will need further experimental confirmation.
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Brophy JM, Lévesque LE, Zhang B. The Risk for Myocardial Infarction with Cyclooxygenase-2 Inhibitors. Ann Intern Med. 2005;143:617–618. doi: 10.7326/0003-4819-143-8-200510180-00023

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Published: Ann Intern Med. 2005;143(8):617-618.

DOI: 10.7326/0003-4819-143-8-200510180-00023

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2005 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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