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Cox-2 Drugs Boost Blood Pressure: Study
Cox-2 Drugs Boost Blood Pressure: Study -- Posted by Roman Bystrianyk on 02-14-05 18:16
http://www.healthsentinel.com/news.php?event=news_print_list_item&id=612
Amanda Gardner, "Cox-2 Drugs Boost Blood Pressure: Study", Forbes,
February 14, 2005,
Link:
http://www.forbes.com/lifestyle/health/feeds/hscout/2005/02/14/hscout523996.html
As a U.S. advisory panel prepares to discuss the future of cox-2 drugs
later this week, a new round of studies debating the cardiovascular
risks of this class of medication has just surfaced.
One study found that cox-2s raise blood pressure more than traditional
nonsteroidal anti-inflammatory inhibitors (NSAIDs) or a placebo. The
research, by Australian scientists, appears in the March 15 issue of
Archives of Internal Medicine, which was released online Monday.
The finding, said Dr. Kevin Stone, an orthopedic surgeon at the Stone
Clinic in San Francisco, is "another nail in the coffin" of cox-2s,
which include Celebrex, Bextra and the now-withdrawn Vioxx.
"It jibes with many other things we know," added Dr. Richard Re, head
of the hypertension section at the Ochsner Clinic Foundation in New
Orleans. "People have had suspicions that this is the case, and this
study more or less confirms it."
Another new study, also released Monday, found that Vioxx and Celebrex
increased patients' risk of heart attack and stroke by about 20
percent, while Bextra increased the risk by 50 percent. The study was
carried out by Indianapolis-based WellPoint Inc., the nation's largest
provider of health benefits, according to the Associated Press. And it
was done ahead of Vioxx' removal last September.
Dr. Sam Nussbaum, WellPoint's executive vice president and chief
medical officer, said Monday that the study is further evidence of an
"increasingly compelling trend" of data that show such drugs elevate
patients' risk of heart attack and stroke.
A third study, involving laboratory research by scientists at Johns
Hopkins University in Baltimore, found more of a middle ground:
Properties of the cox-1 and cox-2 enzymes can both protect and damage
the brain. The authors state this may help explain why some NSAIDs can
relieve pain even while they have other detrimental effects in the
body. The findings appear in the February issue of the Journal of
Neurochemistry.
Traditional NSAIDs such as aspirin and ibuprofen are used to relieve
pain, but are associated with an increased risk of gastrointestinal
problems such as bleeding ulcers. The newer cox-2 inhibitor NSAIDs were
hailed as wonder drugs when they were introduced in the late 1990s
because they relieved pain without the side effects.
Recently, cox-2 inhibitors have been linked to an increased risk of
cardiovascular problems. Vioxx was pulled from the market by its
manufacturer, Merck & Co., after a study showed that long-term use
increased the risk of heart attack and stroke. Celebrex and Bextra,
made by Pfizer, are still available to consumers.
For the Australian study, its authors analyzed results from all 19
randomized controlled trials of cox-2 inhibitors that were published
before May 2004. Blood pressure information was available for 45,451
participants.
Compared with traditional NSAIDs and with placebos, people taking cox-2
inhibitors had higher blood pressure levels, the researchers found.
Participants taking cox-2s had a 60 percent higher chance of elevated
blood pressure compared with a placebo, and a 25 percent higher chance
compared with the older NSAIDs.
Although these increases were statistically "nonsignificant" when
looked at individually, Dr. Henry Krum, senior author of the study,
said he felt the changes were clinically significant or "highly
relevant when applied to a population."
There were few differences between the different cox-2 drugs, although
Vioxx may have been associated with a higher risk compared with
Celebrex, he added.
According to Krum, who is director of the NHMRC Center of Clinical
Research Excellence in Therapeutics at Monash University/Alfred
Hospital in Melbourne, Australia, the study is "not the final word but
certainly a potential contributor." Studies looking specifically at
cardiovascular outcomes now need to be performed, he added.
Dr. Mark Fendrick, professor of internal medicine at the University of
Michigan School of Medicine, felt that a more important message may
have receded in the flurry of what he called often-confusing scientific
articles on cox-2 drugs.
"What's being lost is, what the heck should patients and doctors be
doing and what are the questions they should be asking as all this
conflicting information keeps coming through all these venues," he
said.
And what should patients be doing? If you can, use non-NSAID therapies,
Fendrick said. Consider a cox-2 inhibitor if you are at risk for any
type of stomach injury or if you are at low risk for cardiac problems
and are not taking aspirin.
If you are at cardiac risk or taking aspirin, consider a "traditional
NSAID with a gastrointestinal protective agent," he added.
Stone sees a "seismic shift" happening, with physicians moving to
prescribe natural anti-inflammatories such as glucosamine.
"Unfortunately, marketing got way ahead of the science and most likely
-- whether or not the FDA forces a recall -- most physicians will step
back quite a bit" from cox-2s, Stone said.
Starting Wednesday, an FDA advisory panel will meet for three days to
debate the safety and future of the cox-2 drugs.
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