doi: 10.1161/CIRCULATIONAHA.106.675306
(Circulation. 2007;115:288-291.)
© 2007 American Heart Association, Inc.
Editorial |
Cyclooxygenase Inhibition and Adverse Remodeling During Healing After Myocardial Infarction
From the Division of Cardiology, Department of Medicine and Cardiovascular Research Group, Faculty of Medicine, University of Alberta, Edmonton, Canada.
Reprint requests to B.I. Jugdutt, MBChB, MSc, MD, 2C2 Walter MacKenzie Health Sciences Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada. E-mail bjugdutt@ualberta.ca
Key Words: Editorials • myocardial infarction • pharmacology • prostaglandins • remodeling
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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For over 2 millennia, physicians have strived to relieve pain, heal, and cause no harm. However, we depend on therapeutic drugs that have side effects and unknown pleiotropic effects. A host of publications and media coverage over the last 2 years alerted us to cardiovascular (CV) risks associated with chronic use of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and selective cyclooxygenase (COX)-2 inhibitors (COXIBs). The publicity elicited concern in patients taking these drugs for their valuable antipyretic, analgesic, and antiinflammatory properties and made physicians more vigilant about side effects such as gastrointestinal ulceration, inhibition of platelet aggregation and thrombosis, inhibition of uterine motility, inhibition of prostaglandin (PG)-mediated renal function, and hypersensitivity reactions.
Article p 326
Moreover, randomized clinical trials led to the withdrawal of rofecoxib because of CV concerns. In a trial for the prevention of colorectal adenoma, celecoxib was associated with a dose-related increase in the combined end point of CV death, myocardial infarction (MI), stroke, or heart failure.1 A subsequent publication showed a 2-fold increase in CV risk with celecoxib and a trend to increased blood pressure.2 The Food and Drug Administration reported in April, 2005 that all 3 approved COXIBs (ie, celecoxib, rofecoxib, and valdecoxib) were associated with increased risk of serious adverse CV events compared with placebo, but CV risk was not clearly different when COX-2–selective and –nonselective NSAIDs were compared.3 A large case-control study reported an increased relative risk of MI in the elderly treated with rofecoxib.4 A Danish study concluded that COXIBS in all doses
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