COX-2 Inhibitors and Cardiovascular Events: Deja Vu Du Jour

Cyclooxygenase (COX)-2 inhibitors are effective therapeutic agents for arthritis and pain similar to nonspecific nonsteroidal anti-inflammatory drugs. However, clinical usage of COX-2 inhibitors has been jeopardized by their undesired cardiovascular complications including higher incidence of myocardial infarction, thrombosis and hypertension. One main concern is whether the reported cardiovascular effects of a given COX-2 inhibitor such as rofecoxib (Vioxx) are a "universal" effect applicable to all COX-2 inhibitors initially designed to reduce gastric adverse effect of nonselective COX inhibitors. This review was geared towards updating recent progress in cardiovascular risk related to prostaglandin inhibition resulting from COX-2 inhibitors. The emphasis is on findings in the last three to four years with only occasional references to earlier work. A number of clinical trials have been summarized and the jury is still out there as to whether the benefit outweighs the risk for COX-2 inhibition.