Impact of prolonged cyclooxygenase-2 inhibition on inflammatory markers and endothelial function in patients with ischemic heart disease and raised C-reactive protein - A randomized placebo-controlled study

Background - The impact of cyclooxygenase ( COX)- 2 antagonist treatment on acute coronary risk is controversial. We investigated the effect of prolonged COX-2 inhibition on inflammatory profile and endothelial function in patients with ischemic heart disease and high serum C-reactive protein (CRP) values. Methods and Results - In a double-blind study, 35 stable subjects on low-dose aspirin with greater than or equal to2 previous acute coronary events and 2 of 2 screening CRP values > 2.0 mg/L were randomized to the COX-2 inhibitor rofecoxib ( 25 mg) or placebo daily for 6 months. Serum CRP, interleukin-6 (IL-6), P-selectin, matrix metalloproteinase-9 (MMP-9), and brachial artery endothelial function were evaluated. In the placebo group, CRP ( median) was 3.16 mg/L (25% and 75% quartiles, 1.90 and 5.78 mg/L) at baseline and 4.22 mg/L ( 25% and 75% quartiles, 2.04 and 6.25 mg/L) at 6 months; in the rofecoxib group, CRP was 3.45 mg/L ( 25% and 75% quartiles, 2.08 and 5.78 mg/L) at baseline and 1.41 mg/L ( 25% and 75% quartiles, 1.17 and 4.81 mg/L) at 6 months ( P = 0.03). Rofecoxib compared with placebo also lowered IL-6 at 6 months ( P = 0.0002). There was a significant off-drug effect on CRP and IL-6 levels in the rofecoxib group 3 months after treatment ( P = 0.005 and P = 0.009, respectively). Rofecoxib did not significantly affect P-selectin, MMP-9, and brachial artery vasoreactivity. Conclusions - Prolonged COX-2 inhibition attenuates CRP and IL-6, does not modify P-selectin and MMP-9, and has no deleterious effect on endothelial function in stable patients with a history of recurrent acute coronary events and raised CRP. These results strengthen the rationale for evaluating the clinical benefit of COX-2 inhibition in patients with ischemic heart disease.