Editing Celecoxib (section)

===Heart attack and stroke===
A 2013 meta-analysis of hundreds of clinical trials found that coxibs (the class of drugs that includes celecoxib) increase the risk of major cardiovascular problems by about 37% over placebo.<ref name=Coxib2013>{{cite journal | vauthors = Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C | title = Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials | journal = Lancet | volume = 382 | issue = 9894 | pages = 769–79 | date = August 2013 | pmid = 23726390 | pmc = 3778977 | doi = 10.1016/S0140-6736(13)60900-9 }}</ref> In 2016, a randomized trial provided strong evidence that treatment with celecoxib is not more likely to result in poor cardiovascular outcomes than treatment with naproxen or ibuprofen.<ref name="NissenYeomans2016">{{cite journal | vauthors = Nissen SE, Yeomans ND, Solomon DH, Lüscher TF, Libby P, Husni ME, Graham DY, Borer JS, Wisniewski LM, Wolski KE, Wang Q, Menon V, Ruschitzka F, Gaffney M, Beckerman B, Berger MF, Bao W, Lincoff AM | title = Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis | journal = The New England Journal of Medicine | volume = 375 | issue = 26 | pages = 2519–29 | date = December 2016 | pmid = 27959716 | doi = 10.1056/NEJMoa1611593 | doi-access = free }}</ref> As a result, in 2018 an FDA advisory panel concluded that celecoxib poses no greater risk for causing heart attacks and strokes than the commonly-used NSAIDs ibuprofen or naproxen and recommended that the FDA consider changing its advice to physicians regarding celecoxib's safety.<ref name=NPR2018/>

The COX-2 inhibitor [[rofecoxib]] (Vioxx) was removed from the market in 2004 due to its risk. Like all NSAIDs on the US market, celecoxib carries an FDA-mandated "black box warning" for cardiovascular and gastrointestinal risk. In February 2007, the [[American Heart Association]] warned that with respect to "patients with a prior history of or at high risk for cardiovascular disease... use of COX-2 inhibitors for pain relief should be limited to patients for whom there are no appropriate alternatives, and then, only in the lowest dose and for the shortest duration necessary."<ref name="AHA2007"/>

In 2005, a study published in the ''[[Annals of Internal Medicine]]'' found that cardiovascular effects of COX-2 inhibitors differ, depending on the drug.<ref name="pmid15684203">{{cite journal | vauthors = Kimmel SE, Berlin JA, Reilly M, Jaskowiak J, Kishel L, Chittams J, Strom BL | title = Patients exposed to rofecoxib and celecoxib have different odds of nonfatal myocardial infarction | journal = Annals of Internal Medicine | volume = 142 | issue = 3 | pages = 157–64 | date = February 2005 | pmid = 15684203 | doi = 10.7326/0003-4819-142-3-200502010-00005 | doi-access = free }}</ref> Other COX-2-selective inhibitors, such as rofecoxib, have significantly higher myocardial infarction rates than celecoxib.<ref name="pmid11509060">{{cite journal | vauthors = Mukherjee D, Nissen SE, Topol EJ | title = Risk of cardiovascular events associated with selective COX-2 inhibitors | journal = JAMA | volume = 286 | issue = 8 | pages = 954–9 | year = 2001 | pmid = 11509060 | doi = 10.1001/jama.286.8.954 }}</ref> In April 2005, after an extensive review of data, the FDA concluded it was likely "that there is a 'class effect' for increased CV risk for all NSAIDs".<ref name="Jenkins">{{cite web |vauthors=Jenkins JK, Seligman PJ | title=Analysis and recommendations for Agency action regarding nonsteroidal anti-inflammatory drugs and cardiovascular risk [decision memorandum] | url=https://www.fda.gov/cder/drug/infopage/cox2/NSAIDdecisionMemo.pdf | archive-url=https://web.archive.org/web/20050909082236/https://www.fda.gov/cder/drug/infopage/cox2/NSAIDdecisionMemo.pdf | url-status=dead | archive-date=9 September 2005 | date=6 April 2005 | publisher=U.S. [[Food and Drug Administration]] (FDA) }}</ref> In a 2006 [[meta-analysis]] of randomized control studies, the [[cerebrovascular disease|cerebrovascular events]] associated with COX-2 inhibitors were examined, but no significant risks were found when compared to nonselective NSAIDs or placebos.<ref name="pmid17176361">{{cite journal | vauthors = Chen LC, Ashcroft DM | title = Do selective COX-2 inhibitors increase the risk of cerebrovascular events? A meta-analysis of randomized controlled trials | journal = Journal of Clinical Pharmacy and Therapeutics | volume = 31 | issue = 6 | pages = 565–76 | date = December 2006 | pmid = 17176361 | doi = 10.1111/j.1365-2710.2006.00774.x | s2cid = 40738580 | doi-access = free }}</ref>