COX-2 inhibitors and the development of unstable angina and myocardial infarction

消炎药（有时被称为非甾体抗炎药）广泛用于治疗关节炎和一般用途的止痛药。在澳大利亚，每年开具的这些药物的处方多达1000万张。这些药物的一些旧版本，如布洛芬（如布洛芬）和萘普生（商品名萘普生）会引起严重的副作用。胃的损伤是一个特别的问题，这可能导致严重的出血或溃疡穿孔。很少有人认识到这些药物对心脏和肾脏的不良影响。这类药物的老式成员正迅速被称为COX-2抑制剂的新型药物所取代。在澳大利亚流行的例子是塞来昔布（商品名Celebrex）和罗非昔布（商品名Vioxx）。这些药物被大力宣传为比旧的非甾体抗炎药更安全。就胃而言，这种说法似乎是正确的。然而，新的COX-2抑制剂对循环的影响尚未得到充分评估。最近，有人声称这些药物可能会增加心脏病发作的风险。如果这是真的，这将是COX-2抑制剂所特有的效果，因为在较早的非甾体抗炎药中没有报道。我们计划在纽卡斯尔医院进行一项为期3年的研究，比较一组因心脏病发作或不稳定型心绞痛入院的患者与一组同期入院但非心脏病的对照组患者使用COX-2抑制剂的情况。我们感兴趣的是COX-2抑制剂是否与心脏病发作风险增加有关，以及使用小剂量阿司匹林是否可以防止这种影响。根据研究结果，我们可能能够提高这些药物对有心脏病发作风险的患者的安全性。

Anti-inflammatory drugs (sometimes called NSAIDs) are widely used in the treatment of arthritis and also as general purpose pain killers. Up to 10 million prescriptions are written each year for these drugs in Australia. Some of the older versions of these drugs like ibuprofen (eg Brufen) and naproxen (trade name Naproxen) cause side effects which can be serious. Damage to the stomach is a particular problem and this can lead to serious bleeding or perforation of ulcers. Less well recognized are the adverse effects of these drugs on the heart and the kidneys. The older fashioned members of this class of drug are rapidly being replaced by newer agents known as COX-2 inhibitors. Popular examples in Australia are celecoxib (trade name Celebrex) and rofecoxib (trade name Vioxx). These drugs are heavily promoted as being safer than the older NSAIDs. In the case of the stomach, this claim seems to be correct. However, the effects of the new COX-2 inhibitors on the circulation have not been fully assessed. Recently, claims have been made that these drugs may increase the risk of heart attacks. If this were true, it would be an effect that was unique to COX-2 inhibitors as it has not been reported with the older NSAIDs. We plan to carry out a 3 year study in Newcastle hospitals in which we compare the use of COX-2 inhibitors in a group of patients admitted to hospital with a heart attack or unstable angina with that of a control group of patients who were admitted to hospital around the same time, but not for heart problems. We are interested in whether COX-2 inhibitors are associated with an increased risk of heart attacks and whether use of small doses of aspirin protects against this effect. Depending on the results we may be able to improve the safety of these drugs in patients at risk of heart attacks.