COX-2 drugs may raise risk of repeat heart attack

A large study confirms that Vioxx (rofecoxib), but not Celebrex (celecoxib), is associated with increased risk of a first heart attack. However, people with a prior heart attack may be at increased risk for experiencing another if they use either selective COX-2 inhibitor, the research indicates.

While Vioxx was pulled from the US market due to an elevated risk of heart attacks and stroke in adults, Celebrex remains on the US market.

Previous studies looking at the harmful effects on the heart of COX-2-selective inhibitors have largely excluded patients with a history of heart attack, Dr. James M. Brophy, from the McGill University Health Centre in Montreal, and colleagues note in the journal Heart.

They analyzed data on 125,000 patients, with an average age of 75, who were treated with an NSAID between January 1999 and June 2002.

During an average follow-up of 2.3 years, 3,423 patients experienced a heart attack, and were matched to 68,456 heart attack-free controls. The heart outcomes of current NSAID users were compared with those of subjects who had not used an NSAID in the year prior to the heart attack.

The heart attack rate ratio with Vioxx use was 1.59 in patients with a prior heart attack and 1.23 in those without a previous heart attack. The rate ratio with Celebrex was 1.40 for a repeat heart attack, but not significant for first-time heart attack.

This study, the authors note, is the first to examine in detail the impact of a previous heart attack on the cardiac risk associated with the use of COX-2 inhibitors.

A large randomized trial is required to "more completely and reliably" assess the cardiovascular safety of Celebrex and traditional NSAIDs in this high-risk population, they conclude.

SOURCE: Heart, February 2007.