Key result
Rofecoxib (>25 mg/d) and diclofenac significantly increased the risk of cardiovascular events (RR 2.19, 95% CI 1.64-2.91 and RR 1.40, 95% CI 1.16-1.70), while celecoxib and naproxen did not.
Why the study?
Does the use of individual NSAIDs and cyclooxygenase 2 inhibitors increase the risk of serious cardiovascular events compared to nonuse?
Population
Patients in 17 case-control and 6 cohort studies evaluating cardiovascular events with NSAID or COX-2…
Comparison
Cyclooxygenase 2 inhibitors and nonselective… vs Nonuse or remote use of the drugs
Design
Meta-analysis
Authors
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Supports caution with rofecoxib and diclofenac; confirms differential NSAID risks in observational data but leaves causality open.
Meta-Analysis
Does the use of individual NSAIDs and cyclooxygenase 2 inhibitors increase the risk of serious cardiovascular events compared to nonuse?
Effect estimate: RR 2.19 (95% CI 1.64-2.91)
This meta-analysis of observational studies confirms the cardiovascular risks of rofecoxib, raises safety concerns for the older drug diclofenac, and suggests celecoxib and naproxen do not significantly increase or decrease risk.
McGettigan et al. (2006) conducted a meta-analysis in Cardiovascular events (predominantly myocardial infarction). Cyclooxygenase 2 inhibitors and nonselective NSAIDs (rofecoxib, celecoxib, diclofenac, naproxen, piroxicam, ibuprofen) vs. Nonuse or remote use of the drugs was evaluated on Serious cardiovascular events (predominantly myocardial infarction) (RR 2.19, 95% CI 1.64-2.91). Rofecoxib (>25 mg/d) and diclofenac significantly increased the risk of cardiovascular events (RR 2.19, 95% CI 1.64-2.91 and RR 1.40, 95% CI 1.16-1.70), while celecoxib and naproxen did not.
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