An ongoing trial evaluating the relative cardiovascular safety of the three non-steroidal anti-inflammatory drugs most commonly used internationally for arthritis, celecoxib, ibuprofen, and naproxen, may produce definitive data that can be used in guiding decisions for cardiology patients who require medication for their arthritis, according to an article in the March-April issue of the journal Congestive Heart Failure.

Previous studies have suggested that non-steroidal anti-inflammatory drugs, especially those considered selective for the cyclooxygenase-2 enzyme (Cox-2 inhibitors), increase risk for ischemic events such as myocardial infarction and stroke.

In addition, non-steroidal anti-inflammatory drugs and COX-2 inhibitors increase blood pressure, worsen control of hypertension, and can precipitate heart failure, with important differences among individual agents.

In the current paper, University of Kentucky cardiologist and College of Medicine special faculty member Debabrata Mukherjee wrote:

"The ongoing Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofen or Naproxen (PRECISION) trial will assess the relative cardiovascular safety of three of the most commonly used pain relievers in the treatment of arthritis patients: ibuprofen, naproxen, and celecoxib. The study will primarily enroll patients with osteoarthritis, the most common form of arthritis, who have known coronary heart disease or who have multiple risk factors for heart disease and also some patients with rheumatoid arthritis. Patients will be followed for an average of 18 months to track the occurrence of serious cardiovascular events.

The PRECISION trial will compare celecoxib, the least selective coxib, with ibuprofen, which has a similar selectivity, and with the nonselective naproxen. The trial is therefore less likely to be associated with increased cardiovascular risk for the patients compared with the risk associated with more selective coxibs.

Furthermore, use of low-dose aspirin, which might have an interaction with the ibuprofen, will be permitted in the study. Nevertheless, this study should provide some definitive evidence of the relative cardiovascular safety of the available anti-inflammatory agents."