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Medical Journals
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| News from the Medical Journals Are Cox 2 inhibitors safe in the elderly? Can Aspirin reduce the risk? Ann Intern Med 2005;142:481-489 |
Cox 2 inhibitors (vioxx, bextra, celebrex) continue to be
in the news. Evidence is mounting that cox 2 inhibitors
increase a patient’s risk of heart attack or stroke. They do
this by making platelets more likely to form blood clots.
When these clots form in or go to the coronary or cerebral
arteries we get heart attacks and strokes. Researchers in
this study wanted to find out if Cox 2 inhibitors increase a
patient’s risk of first heart attack. The researchers looked
at the health and insurance records of elderly patients in
Quebec. This study compared patients who had taken
these drugs with patients who had not. The impact of
aspirin usage was also evaluated.
The researchers found that patients taking vioxx were
at increased risk of having there first heart attack at both
low and high doses. Patients taking celebrex, aleve, and
other anti-inflammatory meds were not at increased risk of
heart attack at either low or high doses. Aspirin usage was
found to decrease the risk of heart attack in low dose vioxx
users (25mg/day), but not in high dose vioxx users
(50mg/day).
This study was included a large number of patients and
was well designed increasing the importance of its results.
However, it did have several limitations. It was a
retrospective study that looked back in time and was
dependent on record accuracy and patient memories.
Prospective studies are more reliable and reproducible.
Researchers looked only at patients who had never had a
heart attack. This data cannot necessarily be applied to
patients who have previously had a heart attack. Since
this study appears to reinforce the relative safety of
celebrex, I will continue to prescribe it in patients with
clinically relevant illness.
John D. Riley MD, MPH
April 25, 2005
hoosier housecalls
in the news. Evidence is mounting that cox 2 inhibitors
increase a patient’s risk of heart attack or stroke. They do
this by making platelets more likely to form blood clots.
When these clots form in or go to the coronary or cerebral
arteries we get heart attacks and strokes. Researchers in
this study wanted to find out if Cox 2 inhibitors increase a
patient’s risk of first heart attack. The researchers looked
at the health and insurance records of elderly patients in
Quebec. This study compared patients who had taken
these drugs with patients who had not. The impact of
aspirin usage was also evaluated.
The researchers found that patients taking vioxx were
at increased risk of having there first heart attack at both
low and high doses. Patients taking celebrex, aleve, and
other anti-inflammatory meds were not at increased risk of
heart attack at either low or high doses. Aspirin usage was
found to decrease the risk of heart attack in low dose vioxx
users (25mg/day), but not in high dose vioxx users
(50mg/day).
This study was included a large number of patients and
was well designed increasing the importance of its results.
However, it did have several limitations. It was a
retrospective study that looked back in time and was
dependent on record accuracy and patient memories.
Prospective studies are more reliable and reproducible.
Researchers looked only at patients who had never had a
heart attack. This data cannot necessarily be applied to
patients who have previously had a heart attack. Since
this study appears to reinforce the relative safety of
celebrex, I will continue to prescribe it in patients with
clinically relevant illness.
John D. Riley MD, MPH
April 25, 2005
hoosier housecalls
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Archived Reviews
Does estrogen cause gallbladder disease?
Does C-Reactive Protein predict heart disease?
Is celebrex as likely to cause MI as vioxx?
Cost of Plavix/Aspirin vs Aspirin alone.
Can folate and vitamin B12 reduce hip fracture
after stroke.
Improvements in ischemic heart disease patient
risk with exercise and stress management.
Does estrogen cause gallbladder disease?
Does C-Reactive Protein predict heart disease?
Is celebrex as likely to cause MI as vioxx?
Cost of Plavix/Aspirin vs Aspirin alone.
Can folate and vitamin B12 reduce hip fracture
after stroke.
Improvements in ischemic heart disease patient
risk with exercise and stress management.
