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(Circulation. 2006;114:1028-1035.)
© 2006 American Heart Association, Inc.

Hypertension

Effect of Celecoxib on Cardiovascular Events and Blood Pressure in Two Trials for the Prevention of Colorectal Adenomas

Scott D. Solomon, MD; Marc A. Pfeffer, MD, PhD; John J.V. McMurray, MD; Rob Fowler, MS; Peter Finn, MD; Bernard Levin, MD; Craig Eagle, MD; Ernest Hawk, MD; Mariajosé Lechuga, MD; Ann G. Zauber, PhD; Monica M. Bertagnolli, MD; Nadir Arber, MD; Janet Wittes, PhD, for the APC and PreSAP Trial Investigators

From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (S.D.S., M.A.P., P.F., M.M.B.); Western Infirmary, Glasgow, Scotland, UK (J.J.V.M.); Statistics Collaborative Inc, Washington, DC (R.F., J.W.); University of Texas MD Anderson Cancer Center, Houston, Tex (B.L.); Pfizer Inc, New York, NY (M.J.L., C.E.); Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (N.A.); Memorial Sloan-Kettering Cancer Center, New York, NY (A.Z.); and National Cancer Institute, Bethesda, Md (E.H.).

Correspondence to Scott D. Solomon, MD, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail ssolomon{at}rics.bwh.harvard.edu

Received April 27, 2006; revision received May 30, 2006; accepted June 23, 2006.

Background— Cyclooxygenase-2 (COX-2) inhibitors have been shown to reduce colorectal adenomas but have been associated with increased cardiovascular risk.

Methods and Results— The Adenoma Prevention With Celecoxib (APC) trial studied celecoxib 200 mg twice daily and 400 mg twice daily and the Prevention of Spontaneous Adenomatous Polyps (PreSAP) trial used 400 mg once daily to test the efficacy and safety of celecoxib against placebo in reducing colorectal adenoma recurrence after polypectomy. An independent safety committee for both studies adjudicated and categorized serious cardiovascular events and then combined individual patient data from these long-term trials to improve the estimate of the cardiovascular risk and blood pressure changes associated with celecoxib compared with placebo. For adjudicated cardiovascular events, 77% and 54% in APC and PreSAP, respectively, had 37 months of follow-up. For APC and PreSAP combined, 83 patients experienced cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or heart failure. The hazard ratio for this prespecified composite end point was 2.6 (95% confidence interval [CI], 1.1 to 6.1) in patients taking 200 mg twice daily, 3.4 (95% CI, 1.5 to 7.9) in patients taking 400 mg twice daily in APC, and 1.3 (95% CI, 0.6 to 2.6) in patients taking 400 mg once daily in PreSAP (P for heterogeneity=0.13 comparing the combined doses in APC with the dose in PreSAP). The overall hazard ratio for this composite end point was 1.9 (95% CI, 1.1 to 3.1). Both dose groups in APC showed significant systolic blood pressure elevations at 1 and 3 years (200 mg twice daily: 1 year, 2.0 mm Hg; 3 years, 2.6 mm Hg; 400 mg twice daily: 1 year, 2.9 mm Hg; 3 years, 5.2 mm Hg); however, the 400 mg once daily group in PreSAP did not (P<0.0001 between studies).

Conclusions— Celecoxib at 200 or 400 mg twice daily or 400 mg once daily showed a nearly 2-fold–increased cardiovascular risk. The trend for a dose-related increase in cardiovascular events and blood pressure raises the possibility that lower doses or other dose intervals may be associated with less cardiovascular risk.

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