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Review: selective COX 2 inhibitors increase vascular events more than placebo and naproxen but not more than other NSAIDs

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 Q Do selective cyclo-oxygenase-2 (COX 2) inhibitors increase risk of serious vascular events more than placebo or traditional non-steroidal anti-inflammatory drugs (NSAIDs)?

Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ IM/Ambulatory care ★★★★★★★ Haematology ★★★★★☆☆ Rheumatology ★★★★★★★


Embedded ImageData sources:

Medline and EMBASE/Excerpta Medica (1966 to April 2005), US Food and Drug Administration website, and drug manufacturers.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) ⩾4 weeks in duration that compared a selective COX 2 inhibitor with placebo or a traditional NSAID. 138 RCTs (n = 145 373) met the selection criteria. Investigators and manufacturers provided details on the number of vascular events and person time at risk.

Embedded ImageOutcomes:

myocardial infarction (MI), stroke, and vascular death, and a composite end point of all vascular events.


Selective COX 2 inhibitors increased risk …

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  • For correspondence: Dr C Baigent, University of Oxford, Oxford, UK. colin.baigent{at}

  • Sources of funding: UK Medical Research Council; British Heart Foundation; Cancer Research UK.