To the Editor: The Editorial by Dr Topol on the cardiovascular effects of coxibs1 provides new evidence of the ongoing state of confusion involving patients, physicians, and health authorities. The available scientific data, far from clarifying the matter, add to the confusion. An example is the premature cessation of the Alzheimer Disease Anti-inflammatory Prevention Trial (ADAPT) due to an excess of cardiovascular events in the patients treated with naproxen, a nonselective nonsteroidal anti-inflammatory drug (NSAID) previously associated with a reduction in the risk of myocardial infarction.2
Hasty judgment should be avoided before jumping to the conclusion that the cardiovascular events must be a class effect. In the past, drugs have been withdrawn from the market due to adverse reactions not shared by other compounds of the same pharmacological class. For example, 2 histamine 2 receptor antagonists, oxmetidine3 and niperotidine,4 were found to induce acute liver injury, and their use was prohibited. Nevertheless, ranitidine and other H2-blockers have continued to be safely used by millions of patients. Likewise, although cerivastatin was removed from European and US markets in August 2001 because of a high risk of rhabdomyolysis,5 other statins continue to be used as cholesterol-lowering agents, although under careful medical surveillance.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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