Cardiovascular risks of cyclooxygenase-2 inhibitors and traditional anti-inflammatory drugs: necessary but not sufficient for clinical decision making

Abstract

Cyclooxygenase-2 inhibitors were initially developed, then received regulatory approval and were subsequently widely marketed to achieve effective pain relief in patients with inflammatory conditions while decreasing gastrointestinal complications. Gastrointestinal symptoms as well as signs had been a major concern with the use of traditional non-steroidal anti-inflammatory drugs. Individual clinical judgements about the prescription of cyclooxygenase-2 inhibitors and non-steroidal anti-inflammatory drugs for relief of pain from inflammatory arthritis should not be limited to risks of cardiovascular disease but should also consider gastrointestinal complications, symptoms as well as signs, and other benefits which include, but are not limited to improvements in quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes.

Keywords::

• cardiovascular disease
• COXIBs
• gastrointestinal complications
• NSAIDs
• relief of pain or impairment

Financial & competing interests disclosure

CH Hennekens has received investigator initiated research grant support from Bayer to the Charles E Schmidt College of Medicine at Florida Atlantic University; serves as an independent scientist either as Chair or member of the Data and Safety Monitoring Boards or as an advisor to: Actelion, Amgen, Anthera, AstraZeneca, Bayer, Bristol-Myers Squibb, British Heart Foundation, Canadian Institutes of Health Research, Children's Services Council of Palm Beach County, Food and Drug Administration, Legal counsels for GlaxoSmithKline and Stryker, Lilly, National Institutes of Health, Sunovion and UpToDate. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.