TY - JOUR T1 - Celecoxib for colorectal adenomas increased CV events JF - Evidence Based Medicine JO - Evid Based Med SP - 107 LP - 107 DO - 10.1136/ebm.10.4.107 VL - 10 IS - 4 A2 - , Y1 - 2005/08/01 UR - http://ebm.bmj.com/content/10/4/107.abstract N2 - Solomon SD, McMurray JJ, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med 2005;352:1071–80.OpenUrlCrossRefPubMedWeb of Science 
 
 Q In patients with a history of colorectal neoplasia who are at risk of recurrent adenomatous polyps, how safe is celecoxib with respect to cardiovascular (CV) events? Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Oncology ★★★★★☆☆ Gastroenterology ★★★★★☆☆ Cardiology ★★★★★☆☆ Design: randomised placebo controlled trial (Adenoma Prevention with Celecoxib [APC] Study). Allocation: unclear allocation concealment.* Blinding: blinded (clinicians, patients, judicial assessors of outcomes, and monitoring committee).* Follow up period: 2.8–3.1 years. Setting: 91 sites in the US, Canada, Australia, and the UK. Patients: 2035 patients 32–88 years of age (mean age 60y, 68% men) who had had endoscopic polypectomy to remove colorectal adenomas. Intervention: twice daily celecoxib, 200 mg (n = 685); celecoxib, 400 mg (n = 671); or placebo (n = 679). Patients were stratified by centre and use or non-use of aspirin for CV prophylaxis. Outcomes: composite endpoint of death from CV causes, myocardial infarction (MI), stroke, or heart failure. Secondary composite endpoints included the addition of angina and need for a CV procedure. Patient follow up: all patients completed at least 2.8–3.1 years of follow up (intention to treat analysis). The trial was stopped early with a 77% completion rate. 800 mg/day of celecoxib led to a greater risk of the CV composite endpoint than did placebo (table). The risk decreased slightly when angina (hazard ratio [HR] 2.3, 95% CI 1.1 to … ER -