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

抗炎药（有时称为NSAID）广泛用于治疗关节炎，也可作为通用止痛药。在澳大利亚，每年有多达1000万张处方用于这些药物。这些药物的一些老版本，如布洛芬（如Brufen）和萘普生（商标名Naobenzen）会引起严重的副作用。对胃的损害是一个特别的问题，这可能导致严重出血或溃疡穿孔。不太清楚的是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在迅速被称为考克斯-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（商品名西乐葆）和罗非昔布（商品名万络）。这些药物被大力宣传为比旧的NSAID更安全。就胃而言，这种说法似乎是正确的。然而，新的考克斯-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，这将是考克斯-2抑制剂特有的效应，因为在较早的NSAID中尚未报告。我们计划在纽卡斯尔医院进行一项为期3年的研究，比较考克斯-2抑制剂在一组因心脏病发作或不稳定型心绞痛入院的患者中的使用情况，以及在同一时间入院但不是因心脏问题入院的对照组患者的使用情况。我们感兴趣的是，考克斯-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。根据结果，我们可能能够提高这些药物在心脏病发作风险患者中的安全性。

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.