Healthnotes Newswire — Individuals who are taking one of the newer anti-inflammatory drugs (known as selective COX-2 inhibitors) for arthritis or musculoskeletal pain may be increasing their risk of experiencing a heart attack or related cardiovascular problems, according to a report published recently in the Journal of the American Medical Association.

COX-2 inhibitors, which include rofecoxib (Vioxx®) and celecoxib (Celebrex®), are being widely prescribed for arthritis sufferers. These drugs are preferred by many doctors and patients over the older non-steroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen and naproxen), because they are associated with a significantly lower risk of drug-induced peptic ulcer and gastrointestinal bleeding. However, this new study suggests that COX-2 inhibitors may be more dangerous than originally thought.

Researchers at the Cleveland Clinic analyzed the results of four studies that included a total of approximately 16,000 patients. In one of these studies, patients randomly assigned to receive rofecoxib were more than twice as likely to suffer a cardiovascular event (including heart attack, unstable angina, or stroke) as were patients assigned to receive naproxen. In a study that compared celecoxib and NSAIDs, no difference was seen in the incidence of cardiovascular events. However, in that study, patients were permitted to take low doses of aspirin, which is known to reduce the risk of certain types of heart disease. In contrast, aspirin use was not permitted in the rofecoxib study.

The authors of the new JAMA report concluded that the “available data raise a cautionary flag about the risk of cardiovascular events with COX-2 inhibitors.” The authors considered the possibility that use of low-dose aspirin along with COX-2 inhibitors might prevent the increase in cardiovascular risk associated with these drugs. However, taking aspirin could negate one of the major benefits of COX-2 inhibitors—that is, the reduced risk of drug-induced ulceration and bleeding.

The new study suggests that the relatively low gastrointestinal toxicity of COX-2 inhibitors comes at a price, and underscores the fact that none of the currently available anti-inflammatory drugs are risk-free. For that reason, natural-medicine alternatives for arthritis and musculoskeletal pain deserve more serious consideration. Natural remedies that have been used safely and effectively for osteoarthritis include glucosamine sulfate,¹ chondroitin sulfate,² and niacinamide (vitamin B3),³ although niacinamide therapy should be monitored by a physician because of its potential to put stress on the liver. Patients with rheumatoid arthritis have been reported to benefit from dietary modifications (such as avoiding allergenic foods or consuming a vegetarian diet^{4 5}) or from supplementation with borage oil,⁶ fish oil,⁷ or ginger root.⁸ While natural treatments are not always successful, they are associated with an extremely low risk of adverse effects and may be considered as first-line treatment for some individuals.