1. Farrokh Alemi, Ph.D.

3.  Compare effectiveness  Low dose rofecoxib (Vioxx)  High dose rofecoxib (Vioxx)  Celecoxib  Other medication

4.  Data from Kaiser Permanente in California  All patients age 18–84 years  Treated with the medication  From Jan 1, 1999, to Dec 31, 2001  2,302,029 person-years of follow-up  8,143 cases of serious coronary heart disease  2,210 or 27% fatal.

5.  Study group  18 to 84 years old  At least one prescription  At least 12 months of health plan membership  No diagnosis of other serious diseases  Nested Control Group  Intervention group of high or low dose rofecoxib  Matched control of patients on celecoxib

6. 1. Acute MI  Code 410 (acute myocardial infarction)  Code 411·1 (intermediate coronary syndrome) ▪ Raised creatine kinase MB fraction or troponin I 2. Sudden cardiac death  From hypertensive heart disease, ischaemic heart disease, conduction disorders, dysrhythmias, heart failure, atherosclerotic heart disease, sudden death  From an unknown cause

7.  From ICD-9-CM claims data  Cardiovascular admissions  Emergency room visits for cardiovascular reasons  Outpatient diagnoses for tobacco use  Non-cardiovascular admissions and emergency room visits  Same-day admissions for medical procedures  Outpatient diagnoses of alcohol dependence  Rheumatoid arthritis  From prescription data  Cardiovascular prescription drug use  Hormone replacement therapy  Oral prednisone  Antirheumatic drugs

8.  Logistic regression  10 category score  12 fold increase in risk

9.  Rofecoxib vs celecoxib exposed cases  Older  More likely to be women  More likely to be treated by a rheumatologist  More likely to have used: ▪ anticoagulants ▪ oral prednisone  Lower cardiovascular risk scores compared to patients treated with celecoxib

11. Conclusions