Use of Nonsteroidal Anti-Inflammatory Drugs in Patients With Cardiovascular Disease
| Autor: | Roger S. Blumenthal, Valeriani R. Bead, David Edwards, Joan M. Bathon, Muhammad Amer |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Naproxen
medicine.medical_specialty Platelet Aggregation Gastrointestinal Diseases Pharmacology Risk Assessment Proinflammatory cytokine Humans Medicine Cyclooxygenase Inhibitors Adverse effect Heart Failure Aspirin biology business.industry Anti-Inflammatory Agents Non-Steroidal Thrombosis General Medicine Atherosclerosis Ibuprofen Surgery Cardiovascular Diseases Hemostasis Hypertension Celecoxib biology.protein Cyclooxygenase Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Cardiology in Review. 18:204-212 |
| ISSN: | 1061-5377 |
| DOI: | 10.1097/crd.0b013e3181ce1521 |
| Popis: | Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit production of prostaglandins by acting on cyclooxygenase (COX) isoenzymes 1 and 2. Nonselective NSAIDs inhibit both COX 1 and 2 isoenzymes (eg, ibuprofen and naproxen). Selective NSAIDs act on COX-1 (eg, aspirin) or COX-2 (eg, celecoxib) isoenzymes, respectively. Prostaglandins are produced in platelets and gastric mucosal cells through constitutively expressed COX-1 isoenzyme. They are involved in the regulation of hemostasis, functional integrity of the gastrointestinal and renal tracts, platelet function, and macrophage differentiation. Inhibition of COX-1 isoenzymes impedes platelet aggregation, impairs maintenance of protective gastric mucosal barrier, and affects renal function. Prostaglandin production in inflamed tissue results from de novo induction of COX-2 expression by inflammatory cytokines and other noxious stimuli. Thus, COX-2 isoenzyme inhibition either selectively or nonselectively helps in reducing inflammation in the setting of musculoskeletal disorders. Safety and efficacy of NSAIDs are related to their relative actions on COX-1 or COX-2 inhibition. Given the multisystem (gastrointestinal, hematopoietic, and renal) adverse effect profile of COX-1 inhibition, formulation of NSAIDs with relative COX-2 selectivity became a highly desirable target during the 90's. However, studies in the first half of this decade revealed adverse effects of COX-2 inhibition on the cardiovascular system, including increased risks of myocardial infarction, exacerbation of stable congestive heart failure, and worsening high blood pressure. Randomized trials and meta-analyses confirmed these findings, which led to withdrawal of some of the COX-2 inhibitors from the market by the federal Food and Drug Administration a few years ago. Here, we review the effects of COX-2 isoenzyme inhibitors on the cardiovascular system to provide a safe strategy for prescribing these agents in patients with existing cardiovascular disease. We did not find adequate long-term randomized controlled trials appropriately powered to evaluate cardiovascular outcomes. Potentially, all NSAIDs possess a fair risk of adverse effects on gastrointestinal, cardiovascular, and renal systems. Until more evidence for safety via randomized trials is available, we recommend caution in prescribing COX-1 and 2 inhibitors for musculoskeletal disorders in patients with existing gastrointestinal or cardiovascular conditions. |
| Databáze: | OpenAIRE |
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