Is the Use of Selective COX Inhibitors Associated with an Increased Risk of Cardiovascular Events?

The assumption that long-term treatment with rofecoxib is associated with an increased cardiovascular risk when compared with naproxen is based upon a small number of events in the Vioxx Gastrointestinal Outcomes Research (VIGOR) study. That study, however, was not designed to assess adverse cardiovascular events. A review of the available literature does not support such an assumption. Further studies designed to elucidate whether treatment with cyclooxygenase 2 (COX-2) inhibitors is associated with an increased cardiovascular risk are needed. In patients with a high cardiovascular risk, treatment with COX-2 inhibitors should be combined with aspirin, while the combination of a conventional nonsteroidal anti-inflammatory drug and aspirin ought to be avoided due to an increased risk of adverse gastrointestinal effects.