This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Solomon, D. H. Search for Related Content PubMed Articles by Solomon, D. H. Related Collections Other Treatment Related Article

Editorials

Searching for a Safe Analgesic in Patients With Cardiovascular Disease

Daniel H. Solomon, MD, MPH

From the Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Daniel H. Solomon, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115. E-mail dsolomon@partners.org

Key Words: Editorials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Painful musculoskeletal conditions commonly coexist with cardiovascular disease. Older persons with elevated body mass index are at risk of degenerative arthritis, and low back pain as well as cardiovascular disease. Inflammatory arthritis, including rheumatoid arthritis, lupus, and psoriatic arthritis, are associated with an elevated risk of cardiovascular events. The overlapping epidemiology of arthritis and cardiovascular disease ensures that analgesics will always be widely prescribed to patients at risk for future cardiac events. Thus, even though the selective and some nonselective nonsteroidal antiinflammatory drugs (NSAIDs) are known to be associated with cardiac events, they are widely used even in patients with known cardiovascular disease.

Article see p 155

Several randomized controlled trials comparing COX-2 selective NSAIDs (eg, celecoxib, rofecoxib, and valdeoxib) with nonselective agents or placebo found an elevated risk of cardiac events with the selective agents.^1–3 The cardiac risk observed with the COX-2 selective agents appears to differ by agent and by dosage. However, a number of nonselective NSAIDs also may be associated with cardiovascular risk, such as diclofenac.⁴ Information about nonselective NSAID risk has primarily been derived from observational data, as few randomized controlled trials of adequate duration have examined cardiovascular risk with these agents. What can be learned from observational data regarding the cardiovascular risk of NSAIDs?

Although randomized controlled trials serve as the standard for judging a drug’s efficacy, there are many reasons why trials may not be as useful for assessing toxicity. First, efficacy for arthritis is typically judged at 12 weeks of follow-up and does . . . [Full Text of this Article]

Related Article

Cardiovascular Risks of Nonsteroidal Antiinflammatory Drugs in Patients After Hospitalization for Serious Coronary Heart Disease

Wayne A. Ray, Cristina Varas-Lorenzo, Cecilia P. Chung, Jordi Castellsague, Katherine T. Murray, C. Michael Stein, James R. Daugherty, Patrick G. Arbogast, and Luis A. García-Rodríguez
Circ Cardiovasc Qual Outcomes 2009 2: 155-163. [Abstract] [Full Text] [PDF]