New Arthritis Drugs May Help Heart

Jan. 13, 2003 -- Previous reports have suggested that newer arthritis drugs may increase risk of heart disease, but a new study shows these drugs may actually benefit heart patients by having an anti-inflammatory effect on damaged blood vessels.

Researchers found that Celebrex, used by 14 million Americans to reduce joint inflammation, improved flexibility in "hardened arteries" while reducing inflammation and levels of proteins and fats known to boost risk of heart attack.

"Increasing evidence indicates that [hardening of the arteries] is an inflammatory disease," explains lead researcher Frank Ruschitzka, MD, cardiologist at University Hospital in Zurich. "Thus, anti-inflammatory agents used to treat arthritis, such as COX-2 inhibitors, may not only reduce inflammation in the joints, but could possibly have that same anti-inflammatory benefit in the blood vessel wall. This study is the first to show that relationship."

In addition to reduced inflammation and improved flexibility in blood vessel lining, Ruschitzka found that compared with men getting a placebo, those taking Celebrex had lower levels of a dangerous form of LDL "bad" cholesterol and C-reactive protein -- two factors associated with heart attack.

What's more, it's the first study in recent years that doesn't suggest an increased risk of heart problems from using COX-2 inhibitors, which have been under increasing scrutiny since their introduction in 1996. While Ruschitzka's findings, published in the Jan. 28 issue of Circulation, show a protective effect from Celebrex, another COX-2 drug -- Vioxx -- has been found in several studies to boost risk of heart problems.

Last October, Vanderbilt University researchers reported in The Lancet that a review of 300,000 people taking various types of non-steroidal anti-inflammatory drugs (NSAIDs) showed that Vioxx was linked to twice as many heart attacks as the other medications. And 13 months earlier, a Cleveland Clinic review of data on 8,000 others, published in TheJournal of the American Medical Association, indicated that Vioxx users had twice as many heart attacks as those taking Aleve, an over-the-counter NSAID.

COX-2 inhibitors -- Bextra, Celebrex, and Vioxx -- were designed to reduce arthritis pain and inflammation without the stomach upset and risk of ulcers caused by other NSAIDs such as aspirin and ibuprofen. They are the leading treatments for arthritis and among the world's best-selling prescription drugs, with combined annual sales of about $6 billion. However, just last month, a study suggested that Celebrex is no more effective in preventing recurrent bleeding ulcers in arthritis patients than other treatments.

Although Celebrex was not implicated (or even studied) for boosting heart disease risks in those earlier trials, some researchers suggest that its users have a slightly higher risk of heart attacks compared with those taking "older" NSAIDs.

So why would one COX-2 medication (Celebrex) seem to protect against heart disease while another (Vioxx) seems to cause it?