Circulation. 2005;112:759-770
doi: 10.1161/CIRCULATIONAHA.105.568451
doi: 10.1161/CIRCULATIONAHA.105.568451
(Circulation. 2005;112:759-770.)
© 2005 American Heart Association, Inc.
Special Report |
Cyclooxygenase Inhibition and Cardiovascular Risk
From the Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Mass (E.M.A., J.L.); and Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison (D.D.).
Correspondence to Dr Elliott M. Antman, Cardiovascular Division, Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail eantman@rics.bwh.harvard.edu
Key Words: inflammation • pharmacology • platelets • prostaglandins • thromboxane
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Over the past several months clinicians have been confronted at an escalating rate with reports describing the risks of COX-2 inhibitors (coxibs). Information on this class of drugs appears not only in traditional medical journals and textbooks, but also on the Web sites of regulatory agencies, professional societies, and pharmaceutical manufacturers.1–9 An unusual, but noteworthy, aspect of the state of affairs is the high rate of reporting new findings and opinions (at times voiced in a strident tone) in the lay press.10–13 Understandably, patients are concerned about the potential risks associated with their antiinflammatory medications, and now, either spontaneously or in response to a public health warning, call their healthcare professional with questions or arrive for an office visit armed with publicly accessed information they wish to discuss.
Owing to the widespread use of antiinflammatory drugs and the fact that the reported risks are cardiovascular in nature, we offer the readers of Circulation this special article. Our goals are to provide an overview of the relevant biology and pharmacology, to synthesize the data on the cardiovascular risks associated with antiinflammatory medications, to offer suggestions on strategies for prescribing these medications, and to make observations on the regulatory and research implications of the data and their interpretation.
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Biology of Eicosanoids |
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Eicosanoids are oxidized derivatives of the polyunsaturated long-chain fatty acids, arachidonic acid and eicosapentaenoic acid, that serve many roles in cardiovascular biology and disease. Eicosanoid biosynthesis can be initiated by release of arachidonic acid from membrane phospholipids by lipases (predominantly of the phospholipase A2
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