The Pharmaceutical Journal
Vol 270 No 7232 p71
18 January 2003

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Place for COX-2s in cardiovascular disease?

Initial evidence that selective cyclo-oxygenase-2 (COX-2) inhibition might improve a component of cardiovascular disease was reported in a small study this week.

Dr Frank Ruschitzka, Zurich University Hospital, explains that evidence indicates that atherosclerosis is an inflammatory disease and that anti-inflammatory agents, such as COX-2 inhibitors, used in arthritis could produce the same benefit in blood vessel walls.

The crossover study looked at endothelial function in 14 patients with severe coronary heart disease. All were taking concomitant aspirin and most were taking a statin. Each received celecoxib (Celebrex, 200mg twice a day) or placebo for two weeks.

Celecoxib improved endothelium-dependent vasodilation compared with placebo (3.3 per cent compared with 2.0 per cent, P=0.026). Levels of C-reactive protein (a protein released in reaction to inflammation) were lower after celecoxib, as was oxidised low-density lipoprotein. Levels of prostaglandins did not change.

"Because the reduction of vascular inflammation and oxidative stress have been well documented to contribute to the beneficial prognostic effects of statins and angiotensin-converting enzyme inhibitors, the results of our study suggest that COX-2 inhibition with celecoxib holds the potential as an add-on therapy to presently established standard pharmacotherapy in patients with atherosclerotic vascular disease," the authors say, suggesting large-scale trials are now undertaken.

The study is published online as a rapid track report on the Circulation website.