Effect of selective cyclooxygenase 2 inhibitors and naproxen on short-term risk of acute myocardial infarction in the elderly.

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Abstract
SINCE THEIR RECENT introduction, the selective cyclo-oxygenase (COX) 2 inhibitors have become one of the most widely prescribed groups of drugs in the elderly.1 However, the cardiovascular safety of these agents has recently been questioned. A subanalysis of the Vioxx Gastrointestinal Outcomes Research (VIGOR) trial2 demonstrated a significant increase in the risk of acute myocardial infarction (AMI) for rofecoxib users relative to naproxen users. The absence of a placebo group in this trial and the low event rate in this subgroup analysis make interpretation of these findings difficult. Possible explanations for these observations include an increased risk of AMI for rofecoxib, a cardioprotective effect of naproxen, or both. Alternatively, the findings of the VIGOR trial with respect to AMI may have simply occurred by chance and neither rofecoxib nor naproxen truly affects the risk of AMI.

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