Quan Martin
Professor of Clinical Family Medicine, David Geffen School of Medicine at UCLA, Vice Chair for Academic Affairs, UCLA Department of Family Medicine, Los Angeles, CA, USA.
J Fam Pract. 2017 Apr;66(4 Suppl):S52-S57.
The Vioxx Gastrointestinal Outcomes Research (VIGOR) trial, published in 2000, was the first to raise concerns that NSAIDs (specifically, the COX-2 selective inhibitor rofecoxib) might be associated with a higher risk for cardiovascular (CV) events. As discussed in this article, subsequent trials and meta-analyses have demonstrated a higher CV risk with use of not only COX-2 inhibitors (coxibs) but also certain tNSAIDs. These investigations have contributed to actions by the US Food and Drug Administration (FDA), most recently in July 2015, requiring strengthening of CV risk warnings on labels for all prescription and over-the-counter NSAIDs, despite evidence suggesting that differences in CV risk may exist among the NSAIDs.
2000年发表的万络胃肠道转归研究（VIGOR）试验首次引发了人们对非甾体抗炎药（特别是COX-2选择性抑制剂罗非昔布）可能与心血管（CV）事件较高风险相关的担忧。如本文所讨论的，随后的试验和荟萃分析表明，不仅使用COX-2抑制剂（昔布类），而且某些传统非甾体抗炎药也具有较高的心血管风险。这些调查促使美国食品药品监督管理局（FDA）采取行动，最近一次是在2015年7月，要求加强所有处方和非处方非甾体抗炎药标签上的心血管风险警告，尽管有证据表明不同非甾体抗炎药之间可能存在心血管风险差异。
