The cox-2 impact is an important factor in NSAID cardiovascular risk, but other drug characteristics, some not discussed in the new study, are important as well, Farkouh said.
"What they [the study authors] don't account for is the rise in blood pressure," he said. "Drugs that raise blood pressure are the most toxic. Also important is the half-life of a drug -- how long it stays in the system. They [the authors] don't address that head-on, but they do look at slow release as a variable, which is associated with half-life."
Then there are the possible interactions of a drug with aspirin, which is also widely used for pain relief, Farkouh noted. "The take-home message to patients is that when they are given one of these drugs, they should assess it in terms of all these variables," he said.
Farkouh's view is that "naproxen is the safest drug we have. Its risk profile appears to be consistently low." And while "the jury is still out on Celebrex, it still can have a role in patients at high risk of gastrointestinal bleeding," he said.
Dr. James Brophy, a professor of medicine and epidemiology at McGill University in Montreal who has done NSAID studies, said the new findings "are totally consistent with what has been seen both in clinical trials and observational studies."
The study is yet another signal from a large, real-world database that NSAID use can lead to increased cardiovascular risk, Brophy said.
To learn more about NSAIDs, visit the U.S. Food and Drug Administration.
SOURCES: Michael E. Farkouh, M.D., director, clinical trials, Mount Sinai Cardiovascular Institute, New York City; James Brophy, M.D., professor, medicine and epidemiology, McGill University, Montreal; Nov. 11, 2008,
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