Editing Cyclooxygenase (section)

=== Cardiovascular side-effects of COX inhibitors ===

COX-2 inhibitors have been found to increase the risk of [[Thrombosis|atherothrombosis]] even with short-term use. A 2006 analysis of 138 randomised trials and almost 150,000 participants<ref name="pmid16740558">{{cite journal | vauthors = Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C | title = Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials | journal = BMJ | volume = 332 | issue = 7553 | pages = 1302–8 | date = June 2006 | pmid = 16740558 | pmc = 1473048 | doi = 10.1136/bmj.332.7553.1302 }}</ref> showed that selective COX-2 inhibitors are associated with a moderately increased risk of vascular events, mainly due to a twofold increased risk of [[myocardial infarction]], and also that high-dose regimens of some traditional NSAIDs (such as [[diclofenac]] and [[ibuprofen]], but not [[naproxen]]) are associated with a similar increase in risk of vascular events.

This evidence, however, has been contradicted by the 2016 PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial<ref name="pmid27959716">{{cite journal | vauthors = Nissen SE, Yeomans ND, Solomon DH, Luscher TF, Libby P, Husni ME, Graham DY, Borer JS, Wisniewski LM, Wolski KE, Qiuqing W, Menon V, Ruschitzka F, Gaffney M, Beckerman B, Berger MF, Weihang B, Lincoff AM | title = Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis | journal = NEJM | volume = 375 | issue = 26 | date = December 2016 | pmid = 27959716 | doi = 10.1056/NEJMoa1611593 }}</ref> of 24,081 participants, which shows a lower incidence of cardiovascular death (including hemorrhagic death), nonfatal myocardial infarction, or nonfatal stroke for Celecoxib as compared to both Naproxen and Ibuprofen.

Fish oils (e.g., [[cod liver oil]]) have been proposed as a reasonable alternative for the treatment of [[rheumatoid arthritis]] and other conditions as a consequence of the fact that they provide less cardiovascular risk than other treatments including NSAIDs.<ref name='fish_oils'/>