Selective cyclooxygenase-2 (COX-2) inhibition and risk of acute myocardial infarction or stroke in a population of rheumatoid arthritis and osteoarthritis patients from an administrative medical claims dataset

It has been hypothesized that treatment with selective COX-2 inhibitors (coxibs) creates a prothrombotic state by decreasing the synthesis of the prostaglandin prostacyclin, which has vasodilatory and platelet anti-aggregation effects, leading to adverse cardiovascular (CV) events.; This thesis was based on an analysis of a population based, retrospective cohort study of NSAID use in an adult RA or OA population generated from administrative medical and pharmacy claims data from a large private insurer. We compared incidence rates for CV events in subjects treated with coxibs, NSAIDs, combination users (coxibs and NSAIDs), and non-users of NSAIDs utilizing multivariate Cox proportional hazards models.; Relative to non-users of any NSAID, users of coxibs were found to be at greater risk for a CV event than were subjects treated with nonselective NSAIDs, with the effect most pronounced in treated hypertensive subjects (HR = 2.30, 95% CI 2.24–2.37 and HR = 1.69, 95% CI 1.29–2.20, respectively). Among coxib treated subjects, those treated with rofecoxib were two times more likely to experience a CV event than were celecoxib treated subjects (HR = 2.77, 95% CI 1.36–5.60 and HR = 1.44, 95% CI 1.09–1.79, respectively).