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In Reply: Dr Andersohn and colleagues suggest that the highest risks of cardiovascular events with celecoxib are seen in European study populations, where the CYP2C9*3 allele associated with slow metabolism of celecoxib (and by implication an increased risk of thrombosis) may occur with a frequency of as much as 16%. This is an interesting suggestion, but we can speculate that it may not be the most likely explanation for the heterogeneity observed in the study results.

Based on the likely genotype frequencies, and the possible impact of the slow metabolizer genotype on cardiovascular risk, it appears that the prevalence of black individuals in the United States would have to be higher than 12.1% (the prevalence measured in the 2000 census) to account for the apparent difference in relative risks observed in European and North American study populations. Confounding at study level, due to other factors mentioned by Andersohn et al, . . . [Full Text of this Article]

David Henry, MB, ChB, FRCP
david.henry@newcastle.edu.au

Patricia McGettigan, MD, FRACP
Discipline of Clinical Pharmacology
School of Medicine and Public Health
The University of Newcastle
New South Wales, Australia