Selective cyclooxygenase-2 (COX-2) inhibitors were initially developed to reduce the gastrointestinal toxicity of conventional NSAIDs. However, it became rapidly evident that selective COX-2 inhibitors may increase the risk of cardiovascular events. Today, the mechanisms for the potentially adverse cardiovascular effects of coxibs remain unknown, and it is increasingly clear that our understanding of the role of COX-2 in cardiovascular function is incomplete. Based on some available indirect evidence, and unless more clear-cut data become available, the longterm use of high doses of selective COX-2 inhibitors, in elderly patients or patients with a high cardiovascular risk should be limited whenever possible.