Dec. 7 tip sheet Annals of Internal Medicine

December 06, 2004

1. Different COX-2 Inhibitors Appear to Have Different Cardiovascular Effect

A study being released early online found that the COX-2 inhibitor rofecoxib (brand name Vioxx®) had 2.72 higher odds for heart attack when compared with another COX-2 inhibitor, celecoxib (brand name Celebrex®).

Rofecoxib was also associated with higher odds for heart attack compared with older NANSAIDs (non-selective non-aspirin non-steroidal anti-inflammatory drugs). It was not clear if use of celecoxib was associated with higher odds for heart attack than use of NANSAIDs.

NOTE: Reporters, editors: See schedule for PDF availability below.*)

The study examined patient reports of prior use of rofecoxib and celecoxib (two COX-2 inhibitor pain killers often used for arthritis pain) and NANSAIDs in a group of 1,718 people admitted to hospitals with a first, nonfatal myocardial infarction and a comparison group who did not have myocardial infarction.

They found that people who used the older over-the-counter NANSAIDs had a decreased risk for myocardial infarction compared to those who did not take NANSAIDs or one of the two COX-2 inhibitors. They found no overall class effect of COX-2 inhibitors for heart attack. The authors say "the study supports the hypothesis that different COX-2 inhibitors differ in their cardiovascular effects."

Writers in an accompanying editorial examine possible mechanisms by which NANSAIDs and COX-2 inhibitors reduce inflammation and may affect cardiovascular functioning.

They conclude that "further study is urgently needed to document the safety of COX-2 inhibitors."

In the meantime, they recommend that "physicians should avoid COX-2 inhibitors as a first line agent in patients with cardiovascular risk factors and average risk of gastrointestinal toxicity."

This article and the accompanying editorial will be available online at at 9 a.m. EST, Tuesday, December 7. They will appear in the Feb. 1, 2005, print edition of Annals.)

*NOTE to Editors: The PDF of the early release article will not be available until Friday afternoon, Dec. 3. The PDF of the editorial will not be available until Monday morning, Dec. 6. Please leave e-mail address on voice mail (800-523-1546, ext. 2653) and the PDFs will be sent to you as soon as available. Thank you for your cooperation.

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2. Lack of Sleep Increases Hunger and May Encourage Weight Gain

A study of 12 healthy, young male volunteers in a sleep laboratory found that restricting sleep to four hours per day was associated with changes in levels of two hormones that regulate appetite (Article, p. 846).

When sleep deprived, the volunteers also reported feeling hungry, especially for calorie-dense foods with high carbohydrate content. Researchers say that the study could provide a mechanism linking sleep loss to overeating and eventually to overweight and obesity.

Writers in an accompanying editorial say that millions of Americans are overweight, and the usual suspects are fast food, high-fat food, too much food, and too little exercise (Editorial, p. 885).

It might be possible that a 24/7 lifestyle and lack of sleep also leads to overeating and weight gain, they say. But they point out that this study does not find a cause-effect link between the hormone levels and the feelings of hunger and actual eating, and they say that other factors, such as cortisol or orexin, might affect sleep and body weight regulation.

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3. Sudden Death in Military Recruits Is Rare. Most Deaths Were Caused by Heart Abnormalities Not Found in Pre-Enlistment Physicals, But More Invasive Pre-Enlistment Tests Are Not Justified Now

Article, p. 829; Editorial 882)
Annals of Internal Medicine is published by the American College of Physicians, an organization of 116,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information.

American College of Physicians

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