scholarly journals Cardiovascular risk and inhibition of cyclooxygenase: traditional nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors

2013 ◽  
pp. 37-54
Author(s):  
M. Campanini ◽  
G. Mathieu
Keyword(s):  
Clinical Trials ◽  
Cardiovascular Risk ◽  
Cardiac Failure ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Cardiovascular Effects ◽  
Cardiovascular Toxicity ◽  
Thrombotic Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

BACKGROUND The development of non-selective nonsteroidal anti-inflammatory drugs (tNSAIDs) and, more recently, of selective inhibitors of the cycloooxygenase-2 isoform (COXIBs), has contributed greatly towards the effective management of patients with arthritis and pain complaints. Although COXIBs have demonstrated an improved gastrointestinal tolerability compared with tNSAIDs, the cardiovascular effects of the two drugs types are much controversial. By blocking prostacyclin formation but leaving platelet-derived thromboxane A2 generation unopposed, the potential gastrointestinal benefit of COXIBs may come at cost of increased thrombotic risk. AIM OF THE STUDY This review aims at analysing the cardiovascular effects of the tNSAIDs and COXIBs. METHOD This review addresses the controversy of effects of COXIBs and tNSAIDs in 4 segments. It begins with a discussion about pathophysiological effects of cyclooxygenase inhibition on cardiovascular system. This is followed by a systematic review and meta-analysis of a control, randomized, double blind study and population-based matched case-control study to compare the risk of serious cardiovascular events with tNSAIDs and COXIBs. Then it answers to key questions with the aim to assist the clinicians for a systematic approach to evaluate the risk-benefit-ratio of NSAIDs in the clinical practice. Finally we analyse the open questions associated with the use of NSAIDs and the cardiovascular events. RESULTS The use of rofecoxib demonstrated an increase in adverse cardiovascular events. This toxic effect is not dose-related. The relationship between celecoxib and cardiovascular risk is less clear. The results of different clinical trials are conflicting: some didn’t demonstrate increase in cardiovascular toxicity but the APC study and recently a metanalysis reported a significant incidence of adverse cardiovascular events. Also valdecoxib and parecoxib appear to have increased risk for cardiovascular toxicity. Eterocoxib is still the object of three ongoing clinical trials. The TARGET study demonstrated for lumiracoxib a low increase in cardiovascular events compared with ibuprofen and naproxen. Also the use of ibuprofen (800 mg t.i.d.), diclofenac (75 mg b.i.d.) and indomethacin is reported to cause adverse cardiovascular events. The use of naprosen shows a better profile regarding cardiovascular toxicity. tNSAIDSs can worse clinical condition of patients affected by chronic cardiac failure and rofecoxib but not celecoxib can disclose clinical cardiac failure. A politherapy with both tNSAIDs and rofecoxib demonstrated an increase of blood arterial pressure and peripheral oedema. CONCLUSIONS This review confirms the findings from randomized trials, meta-analysis and observational studies regarding the risk of cardiovascular events with rofecoxib, valdecoxib e parecoxib, whereas the evidence for other COXIBs is not so clear. Also in the class of tNSAID some drugs (diclofenac and ibuprofen) can have an increased cardiovascular toxicity.

scholarly journals Hydroxychloroquine: Looking into the Future

2017 ◽  
Vol 24 (4) ◽  
pp. 369-375 ◽  
Author(s):  
Saibal Chakravorty ◽  
Indranil Purkait ◽  
Anil Pareek ◽  
Avinash Talware
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Systemic Inflammation ◽  
Cardiovascular Effects ◽  
Lipid Lowering ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

AbstractHydroxychloroquine, an antimalarial agent has also been found to possess antidiabetic action. Onset of type-2 diabetes (T2DM) and cardiovascular disease is now considered to be the outcome of systemic inflammation. Many clinical trials are targeting systemic inflammation to reduce cardiovascular risk. Anti-inflammatory drugs with cardiovascular effects may be valuable therapeutic intervention to reduce massive cardiovascular risk in T2DM. In this review, antidiabetic action and potential cardioprotective role of hydroxychloroquine has been discussed. By virtue of its antidiabetic, lipid lowering, anti-platelet, anticoagulant and anti-inflammatory properties, hydroxychloroquine can be a key therapeutic alternative to manage patients with T2DM.

Meta-Analysis: Cardiovascular Events Associated with Nonsteroidal Anti-inflammatory Drugs

2006 ◽  
Vol 119 (7) ◽  
pp. 552-559 ◽  
Author(s):  
Shelley R. Salpeter ◽  
Peter Gregor ◽  
Thomas M. Ormiston ◽  
Richard Whitlock ◽  
Parminder Raina ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Meta Analysis ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials

2020 ◽  
Vol 48 (3) ◽  
pp. 293-307 ◽  
Author(s):  
Edson Luiz Cetira Filho ◽  
Francisco Samuel Rodrigues Carvalho ◽  
Paulo Goberlânio de Barros Silva ◽  
Daniel Almeida Ferreira Barbosa ◽  
Karuza Maria Alves Pereira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Surgical Removal ◽  
Third Molars ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Anti-Inflammatory Drugs in Patients with Ischemic Heart Disease

2021 ◽  
Vol 10 (13) ◽  
pp. 2835
Author(s):  
Ana María Pello Lázaro ◽  
Luis M. Blanco-Colio ◽  
Juan Antonio Franco Peláez ◽  
José Tuñón
Keyword(s):  
Clinical Trials ◽  
Acetylsalicylic Acid ◽  
Cardiovascular Events ◽  
Randomized Clinical Trials ◽  
Renin Angiotensin System ◽  
Clinical Settings ◽  
Potential Candidate ◽  
Angiotensin System ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Inflammation has long been known to play a role in atherogenesis and plaque complication, as well as in some drugs used in therapy for atherosclerotic disease, such as statins, acetylsalicylic acid, and modulators of the renin-angiotensin system, which also have anti-inflammatory effects. Furthermore, inflammatory biomarkers have been demonstrated to predict the incidence of cardiovascular events. In spite of this, and with the exception of acetylsalicylic acid, non-steroidal anti-inflammatory drugs are unable to decrease the incidence of cardiovascular events and may even be harmful to the cardiovascular system. In recent years, other anti-inflammatory drugs, such as canakinumab and colchicine, have shown an ability to reduce the incidence of cardiovascular events in secondary prevention. Colchicine could be a potential candidate for use in clinical practice given its safety and low price, although the results of temporary studies require confirmation in large randomized clinical trials. In this paper, we discuss the evidence linking inflammation with atherosclerosis and review the results from various clinical trials performed with anti-inflammatory drugs. We also discuss the potential use of these drugs in routine clinical settings.

scholarly journals Cardiovascular safety of celecoxib in rheumatoid arthritis and osteoarthritis patients: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261239
Author(s):  
Bai-Ru Cheng ◽  
Jia-Qi Chen ◽  
Xiao-Wen Zhang ◽  
Qin-Yang Gao ◽  
Wei-Hong Li ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Biomedical Literature ◽  
Cardiovascular Safety ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Objective To assess the cardiovascular safety of celecoxib compared to non-selective non-steroid anti-inflammatory drugs or placebo. Methods We included randomized controlled trials of oral celecoxib compared with a non-selective NSAID or placebo in rheumatoid arthritis and osteoarthritis patients. We conducted searches in EMBASE, Cochrane CENTRAL, MEDLINE, China National Knowledge Infrastructure, VIP, Wanfang, and Chinese Biomedical Literature Database. Study selection and data extraction were done by two authors independently. The risk of bias was assessed using Cochrane’s risk-of-bias Tool for Randomized Trials. The effect size was presented as a risk ratio with their 95% confidence interval. Results Until July 22nd, 2021, our search identified 6279 records from which, after exclusions, 21 trials were included in the meta-analysis. The overall pooled risk ratio for Antiplatelet Trialists Collaboration cardiovascular events for celecoxib compared with any non-selective non-steroid anti-inflammatory drugs was 0.89 (95% confidence interval: 0.80–1.00). The pooled risk ratio for all-cause mortality for celecoxib compared with non-selective non-steroid anti-inflammatory drugs was 0.81 (95% confidence interval: 0.66–0.98). The cardiovascular mortality rate of celecoxib was lower than non-selective non-steroid anti-inflammatory drugs (risk ratio: 0.75, 95% confidence interval: 0.57–0.99). There was no significant difference between celecoxib and non-selective non-steroid anti-inflammatory drugs or placebo in the risk of other cardiovascular events. Conclusion Celecoxib is relatively safe in rheumatoid arthritis and osteoarthritis patients, independent of dose or duration. But it remains uncertain whether this would remain the same in patients treated with aspirin and patients with established cardiovascular diseases.

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