Review: Selective COX 2 inhibitors increase vascular events more than placebo and naproxen but not more than other NSAIDs.

M e t h o d s Data sources: MEDLINE and EMBASE/ Excerpta Medica (1966 to April 2005), U.S. Food and Drug Administration Web site, and drug manufacturers. Study selection and assessment: Randomized controlled trials (RCTs) ≥ 4 weeks in duration that compared a selective COX2 inhibitor with placebo or a traditional NSAID. 138 RCTs (n = 145 373) met the selection criteria. Investigators and manufacturers provided details on the number of vascular events and person-time at risk. Outcomes: Myocardial infarction (MI), stroke, and vascular death, and a composite endpoint of all vascular events.