Background: Studies have postulated that cyclooxygenase-2(COX-2) selective inhibitors affect cardiovascular risk through various mechanisms. Some of these mechanisms could increase risk(for example, inhibition of pros...Background: Studies have postulated that cyclooxygenase-2(COX-2) selective inhibitors affect cardiovascular risk through various mechanisms. Some of these mechanisms could increase risk(for example, inhibition of prostacyclin production), and some could decrease risk(for example, inhibition of inflammation). Objective: To determine the effect of COX-2 inhibitors on risk for nonfatal myocardial infarction(MI). Design: Case-control study. Setting: 36 hospitals in a 5-county area. Participants: 1718 case-pa-tients with a first, nonfatal MI admitted to these hospitals and 6800 controls randomly selected from the same counties. Measurements: Self-reported medication use assessed through telephone interviews. Results: The adjusted odds ratio for MI among celecoxib users, relative to persons who did not use nonaspirin nonsteroidal anti-inflammatory drugs(NSAIDs), was 0.43(95%CI, 0.23 to 0.79) compared with 1.16(CI, 0.70 to 1.93) among rofecoxib users. The use of rofecoxib was associated with a statistically significant higher odds of MI compared with the use of celecoxib(adjusted odds ratio for rofecoxib vs. celecoxib, 2.72[CI, 1.24 to 5.95]; P=0.01). Nonselective NSAIDs were associated with a reduced odds of nonfatal MI relative to nonusers. Comparisons of COX-2 inhibitors with nonselective NSAIDs were the following: rofecoxib versus naproxen(odds ratio,3.39[CI, 1.37 to 8.40]) and celecoxib versus ibuprofen or diclofenac(odds ratio, 0.77[CI, 0.40 to 1.48]). Limitations: The possibility of recall bias and uncontrolled confounding in this observational study limit the ability to make definitive conclusions. The association of celecoxib with a lower odds of MI could have occurred by chance. Only about 50%of eligible participants completed telephone interviews. Conclusion: Celecoxib and rofecoxib were associated with different odds of MI. Cardiovascular effects among the COX-2 inhibitors seem different, but further studies, preferably randomized trials, are needed to fully understand the spectrum of effects of COX-2 inhibitors and potential differences among them.展开更多
Angiotensin-converting enzyme(ACE) inhibitors differ in their affinity for tissue-boundACE. It has been hypothesized that tissue ACE affinity might be responsible for some of the beneficial cardiovascular properties o...Angiotensin-converting enzyme(ACE) inhibitors differ in their affinity for tissue-boundACE. It has been hypothesized that tissue ACE affinity might be responsible for some of the beneficial cardiovascular properties of ACE inhibitors. The present study examined this question and found no correlation between tissue ACE affinity and risk of first nonfatal myocardial infarction in patients who have hypertension.展开更多
文摘Background: Studies have postulated that cyclooxygenase-2(COX-2) selective inhibitors affect cardiovascular risk through various mechanisms. Some of these mechanisms could increase risk(for example, inhibition of prostacyclin production), and some could decrease risk(for example, inhibition of inflammation). Objective: To determine the effect of COX-2 inhibitors on risk for nonfatal myocardial infarction(MI). Design: Case-control study. Setting: 36 hospitals in a 5-county area. Participants: 1718 case-pa-tients with a first, nonfatal MI admitted to these hospitals and 6800 controls randomly selected from the same counties. Measurements: Self-reported medication use assessed through telephone interviews. Results: The adjusted odds ratio for MI among celecoxib users, relative to persons who did not use nonaspirin nonsteroidal anti-inflammatory drugs(NSAIDs), was 0.43(95%CI, 0.23 to 0.79) compared with 1.16(CI, 0.70 to 1.93) among rofecoxib users. The use of rofecoxib was associated with a statistically significant higher odds of MI compared with the use of celecoxib(adjusted odds ratio for rofecoxib vs. celecoxib, 2.72[CI, 1.24 to 5.95]; P=0.01). Nonselective NSAIDs were associated with a reduced odds of nonfatal MI relative to nonusers. Comparisons of COX-2 inhibitors with nonselective NSAIDs were the following: rofecoxib versus naproxen(odds ratio,3.39[CI, 1.37 to 8.40]) and celecoxib versus ibuprofen or diclofenac(odds ratio, 0.77[CI, 0.40 to 1.48]). Limitations: The possibility of recall bias and uncontrolled confounding in this observational study limit the ability to make definitive conclusions. The association of celecoxib with a lower odds of MI could have occurred by chance. Only about 50%of eligible participants completed telephone interviews. Conclusion: Celecoxib and rofecoxib were associated with different odds of MI. Cardiovascular effects among the COX-2 inhibitors seem different, but further studies, preferably randomized trials, are needed to fully understand the spectrum of effects of COX-2 inhibitors and potential differences among them.
文摘Angiotensin-converting enzyme(ACE) inhibitors differ in their affinity for tissue-boundACE. It has been hypothesized that tissue ACE affinity might be responsible for some of the beneficial cardiovascular properties of ACE inhibitors. The present study examined this question and found no correlation between tissue ACE affinity and risk of first nonfatal myocardial infarction in patients who have hypertension.
