Monday, March 08, 2010


The March 9th issue of the Journal of the American College of cardiology carried a small but interesting, hypothesis generating paper on the interaction of celecoxib ( a COX2-inhibitor for pain relief ) and rosuvastatin ( a new-kid on the block statin ). Dr Andrew Liuni and group studied 20 volunteers and gave them rosuvastatin and studied their " ischemic threshold " through the flow mediated response in the forearm, after a 40 mg dose of rosuvastatin, and then studied them after a few days of celecoxib. They found that with rosuvastatin alone, there was an increase in ischemic threshold which was blunted by the subsequent use of celecoxib.
This is indeed very interesting.
In cardiology and ischemic heart disease, there is this concept of " ischemic preconditioning " meaning that if you have heart artery blockages causing ischemia ( lack of block supply ), frequent small dosease of ischemia allows you to tolerate more ischemia, so that should a "big" ischemia happen, you are better to tolerate it with more limited consequences. This concept is well proven from the seminal work of pass cardiac researches like James Willerson and company. This paper by Dr Liuni is very interesting in that it showed that statins can help ischemic pre-conditioning, and more, that celecoxib can blunt it.
It is a small study and does not really prove it, but it is hypothesis generating, allowing us to understand disease concepts better. It may be that ischemic pre-conditioning is a platelet mediated phenomenon and that the COX2 receptors maybe involved in some way and that blocking the COX2 receptors, maybe abolishing the response.
Whatever it may, it does look like there is some significant interaction between statins and COX2 - inhibitors and they should be used together with some caution. We do not wish for our patients to get heart attacks through our wrong use of medications.

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