Title: Temporal Relationship between Use of NSAIDs, Including Selective COX-2 Inhibitors, and Cardiovascular Risk
Authors: Motsko SP, Rascati KL, Busti AJ, Wilson JP, Barner JC, Lawson KA, Worchel J
Source: Drug Safety, 2006; 29 (7): 621-631
PODIATRIC RELEVANCE:
NSAIDs and COX-2 inhibitors are frequently prescribed by podiatric physicians. This study assesses the cardiovascular risk when prescribing these medications.
METHODS:
A 2 year retrospective analysis of patients in the VA Heart of Texas Health Care Network. The database was used to identify patients’ drug exposure, cardiovascular risk factors, and study endpoint events. Patients over 35 who had received a non-selective or selective COX-2 inhibitor over a 2 year period were included. There were 5 total study groups based on which study medication the patients received; naproxen, ibuprofen, etodolac, celecoxib, and rofecoxib. Ibuprofen was used as the control group. 4,481 patients received Ibuprofen. 3,240 patients received naproxen. 1,530 patients were prescribed celecoxib, 2,371 used etodolac, and 566 were prescribed rofecoxib.
Exclusion criteria: patients who received a prescription for any NSAID within the 6 months prior to the study, exposure to a cohort-defining drug in the year prior to the index date, patients who received less than 30 days of study medication, patients who were dispensed more than one of the study medications. The data was reviewed at 60, 90, 120, 150, 210, and 240 days. Study endpoints were defined as an acute myocardial infarction and/or cerebrovascular event.
RESULTS:
90 % of the patients in the study were male. Patients taking celecoxib and rofecoxib were on average 7 years older and had more co-morbidities including diabetes and cardiovascular conditions than the other medication groups. Overall, when adjustments were made for covariates, there was not a statistical significance between overall use of the study medications compared to Ibuprofen. There was a statistically significant cardiovascular risk in patients with COPD, osteoarthritis, prior heart attack or stroke, age and beta-blockers, loop diuretics, methotrexate, or antiplatelets taking celecoxib and rofecoxib. There was also an increased cardiovascular risk with long term use of celecoxib and rofecoxib when compared to ibuprofen. Short-term use of any of the NSAIDS was not associated with increased cardiovascular risk.
COMMENTS:
Podiatric physicians prescribe NSAIDs to treat a myriad of foot and ankle conditions. These medications have the potential to both help and harm the patients we are treating. It is important to review the patients’ full medical history and medications prior to prescribing any new medication. This article illustrates that with careful patient selection, a patient can safely take a COX-2 inhibitor for a short period of time.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.