Risk assessment and management of myocardial infarction.

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] The family of cyclooxygenases plays a crucial role in platelet activation1 and inflammation.2 While cyclooxygenase-1 is constitutively expressed in platelets and is the rate-limiting enzyme for thromboxane A2 formation, cyclooxygenase-2 is an inducible enzyme in most tissues and is involved in inflammatory reactions and atherosclerosis.3 Also, while aspirin is widely used as an antithrombotic agent in cardiovascular patients,4 inhibitors of cyclooxygenase-2 or of both enzymes are effective for pain relief, mainly in patients with osteoarthritis. Morten Schmidt from the Aarhus University Hospital in Denmark discusses the latter drugs in the Current Opinion ‘ Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology ’.5 The cardiovascular risks of non-aspirin non-steroidal anti-inflammatory drugs or NSAIDs have received a lot of attention in the last decade.6–8 Current evidence suggests that non-aspirin NSAIDs differ in their effects on blood pressure and in heart failure, as well as with regards to the risk of thrombotic events associated with their use. In particular, selective cyclooxygenase-2 inhibitors such as rofecoxib and possibly others have been associated with adverse vascular risks,9 but traditional NSAIDs, specifically diclofenac, may also exert untoward effects in cardiovascular patients. The authors summarize current evidence on the cardiovascular safety of these drugs and recommendations for their use. As a cause of ischaemia and … [1]: /embed/inline-graphic-1.gif