March 11, 2004 (New Orleans) — The popular arthritis drug Vioxx is once again causing concern among heart specialists. This time, a study suggests that taking both Vioxx and high blood pressure medications doubles the risk of a heart attack.
Andrew Whelton, MD, of Universal Clinical Research Center in Hunt Valley, Md., tells WebMD he analyzed medical insurance claims from more than 34,000 arthritis patients to determine if arthritis drugs such as Vioxx and Celebrex, as well as ibuprofen, naproxen, and aspirin, increased the risk for heart attacks.
After accounting for other factors that increase the risk of a heart attack, such as age and a history of heart attack, Vioxx was the only drug that increased the risk of a heart attack. But the risk was only significant among people taking medications to treat high blood pressure.
Whelton, who presented his findings at the American College of Cardiology Scientific Session 2004, says he isn’t recommending that arthritis patients avoid Vioxx. But he says he thinks that doctors should carefully consider using the drug in patients who are also being treated for high blood pressure.
Asked why Vioxx appeared to increase the risk for heart attack when other arthritis treatments did not, Whelton says, “We think it is a problem with the molecule, rather than with the drug’s effect on inflammation.” But he says that more research is needed for a definitive answer.
Vioxx Under Scrutiny
This isn’t the first time that Vioxx has come under fire from heart specialists. In 2001, researchers at The Cleveland Clinic reported in The Journal of the American Medical Association that people taking Vioxx or Celebrex for arthritis were twice as likely to have a heart attack as patients taking the arthritis drug naproxen. In 2002, the FDA required that the Vioxx label be changed to include information about possible increased risk of heart attack.
Vioxx and Celebrex are newer versions of anti-inflammatory drugs for arthritis called Cox-2 inhibitors. They were created to help decrease some of the side effects of older anti-inflammatory drugs, such as ulcers and bleeding in the stomach. Bextra is the third and newest drug in this group.
Robert Harrington, MD, professor of medicine at Duke University in Durham, N.C., tells WebMD that a head-to-head trial between Vioxx and Celebrex would be the only way to “really answer this question about increased risk.” Harrington was not involved in Whelton’s study.
Meanwhile, Harrington says he wouldn’t advise taking patients off Vioxx although he does suggest continued monitoring.