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To the Editor: The Editorial by Dr Topol on the cardiovascular effects of coxibs¹ provides new evidence of the ongoing state of confusion involving patients, physicians, and health authorities. The available scientific data, far from clarifying the matter, add to the confusion. An example is the premature cessation of the Alzheimer Disease Anti-inflammatory Prevention Trial (ADAPT) due to an excess of cardiovascular events in the patients treated with naproxen, a nonselective nonsteroidal anti-inflammatory drug (NSAID) previously associated with a reduction in the risk of myocardial infarction.²

Hasty judgment should be avoided before jumping to the conclusion that the cardiovascular events must be a class effect. In the past, drugs have been withdrawn from the market due to adverse reactions not shared by other compounds of the same pharmacological class. For example, 2 histamine 2 receptor antagonists, oxmetidine³ and niperotidine,⁴ were found to induce acute liver injury, and their use was . . . [Full Text of this Article]

Mario Guslandi, MD
guslandi.mario@hsr.it
Gastroenterology Unit
S. Raffaele University Hospital
Milan, Italy

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