Selectivity of NSAIDs for COX-2 and cardiovascular outcome

S R J Maxwell, R A Payne, G D Murray, D J Webb

Research output: Contribution to journalReview article (Academic Journal)peer-review


BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) with increased selectivity for the cyclooxygenase-2 (COX-2) isoform reduce gastrotoxicity but may increase adverse cardiovascular events.

METHODS: We searched the literature for studies that reported the odds ratio (OR) for such events following exposure to NSAIDs.

RESULTS: For studies comparing NSAID use with no use, increased COX-2 selectivity was significantly related to cardiovascular risk (log OR) amongst observational studies (R = -0.34, P < 0.001) and randomized controlled trials (RCTs) (R = -0.56, P < 0.001). For studies comparing NSAIDs, difference in selectivity was related to risk for observational studies (R = -0.28, P = 0.005) but not for RCTs (R = -0.23, P = 0.15).

CONCLUSIONS: Although increased COX-2 selectivity may reduce gastrotoxicity, this may be at the cost of increasing cardiovascular risk.

Original languageEnglish
Pages (from-to)243-5
Number of pages3
JournalBritish Journal of Clinical Pharmacology
Issue number2
Publication statusPublished - Aug 2006


  • Anti-Inflammatory Agents, Non-Steroidal/adverse effects
  • Cardiovascular Diseases/chemically induced
  • Cyclooxygenase 2/metabolism
  • Humans
  • Research Design
  • Risk Factors


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