Do long-acting bronchodilators increase the risk of cardiovascular events in patients with chronic obstructive pulmonary disease?

Bottom Line

Long-acting bronchodilators — beta-agonists and anticholinergics — are associated with a small increase in the risk of an emergency department visit or hospitalization for a cardiovascular event. There was no significant difference between the 2 classes in this study. (LOE = 3b)

Reference

Gershon A, Croxford R, Calzavara A, et al. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med 2013;173(13):1175-1184.

Study design: case-control

Setting: population

Funding: foundation

Allocation: unknown

Synopsis

These Canadian investigators conducted a nested case-control analysis to compare the risk of an emergency department visit or hospitalization for a cardiovascular event between patients using newly prescribed inhaled long-acting beta-agonists (salmeterol or formoterol) and those using the anticholinergic tiotropium (dry powder Handihaler). The authors used health administrative data for the province of Ontario, which includes approximately 1.8 million patients aged at least 65 years. They also used the Ontario COPD database, a validated registry of all Ontario patients with chronic obstructive pulmonary disease. A total of 28% of the 191,005 patients had at least one hospitalization or emergency department visit for a cardiovascular event. After matching patients and adjusting for risk factors, long-acting bronchodilators were associated with a small but significantly higher risk (odds ratios = 1.31 for beta-agonists and 1.14 for anticholinergics). The study didn’t include tiotropium mist inhaler (Respimat), available in the United Kingdom, which has been associated with increased mortality as compared with other long-acting bronchodilators.

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA

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