Mukherjee and colleagues state that there is no definitive evidence that naproxen has a cardioprotective effect despite the results of 3 recent observational studies in the ARCHIVES.1- 3 They cite the results of a very large observational study by Ray et al4 in which the incidence of coronary heart disease (defined as acute myocardial infarction or coronary heart disease death) was the same in patients using NSAIDs as in patients matched for age and sex not taking NSAIDs. Furthermore, they reported that the incidence of coronary heart disease was the same in patients taking naproxen as in those not taking an NSAID. However, the use or nonuse of over-the-counter aspirin was not known in this observational study. The use or nonuse of aspirin in patients with cardiovascular indications for its use is critically important. In the CLASS trial,5 patients were allowed to take aspirin in addition to the study medication. There was no difference in the incidence of myocardial infarction in those taking the COX-2 inhibitor celecoxib than in those taking a nonselective NSAID (ibuprofen or diclofenac). In the VIGOR study,6 patients were not allowed to take aspirin. The incidence of myocardial infarction was higher in those taking a COX-2 inhibitor (rofecoxib) than in those taking a nonselective NSAID (naproxen). Nearly 40% of the myocardial infarctions in the VIGOR study occurred in the 4% of patients enrolled in the study who had a cardiovascular indication for aspirin but were not taking aspirin.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.