Matthew B. Stanbrook, MD, PhD
In newly diagnosed patients with chronic obstructive pulmonary disease (COPD), do inhaled anticholinergic medications increase risk for cardiovascular (CV) events?
Retrospective cohort study.
Veteran’s Health Administration centers in the USA.
82 717 patients 40 to 100 years of age (mean age 67 y, 97% men) who were newly diagnosed with COPD in 1998 to 2002. Exclusion criteria included diagnosis of asthma in the year before or at any time after cohort entry, use of a drug for COPD or asthma in the previous year, and use of an asthma drug not approved for COPD after cohort entry.
Use of an inhaled anticholinergic drug.
Composite endpoint of CV events (hospitalization for heart failure, acute coronary syndromes, or cardiac dysrhythmia).
44% of patients received a prescription for an inhaled anticholinergic drug, only 0.02% of which were for tiotropium; the remainder were for ipratropium bromide in various formulations. 6234 CV events occurred during 274 025 patient-years of follow-up (2.2/100 patient-y). Exposure to anticholinergics was associated with a 29% increase in risk for CV events (Table). Compared with unexposed patients, risk for CV events was increased in patients who received an anticholinergic drug in the previous 6 months (with no dose effect) but not in those whose last exposure was > 6 months before (Table).
In newly diagnosed patients with chronic obstructive pulmonary disease, recent use of inhaled ipratropium bromide was associated with increased risk for cardiovascular events.
Risk for cardiovascular events with use of inhaled anticholinergic medications (mainly ipratropium bromide) in patients with chronic obstructive pulmonary disease (COPD)*
*CI defined in Glossary.
†Number of standard 30-d equivalents of inhaled anticholinergics used in the past year. A standard 30-d equivalent was 36 µg of ipratropium bromide by metered-dose inhaler or 0.5 mg by nebulizer 4 times/d for 30 d, or 18 µg of tiotropium once daily for 30 d.
‡Adjusted for age, sex, race, cardiovascular risk factors, COPD severity, distance to a VA hospital, year of cohort entry, number of COPD exacerbations, and use of short-acting β2-agonists or other respiratory drugs.
Stanbrook MB. Recent use of ipratropium bromide increased risk for cardiovascular events in chronic obstructive pulmonary disease. Ann Intern Med. ;153:JC1–3. doi: 10.7326/0003-4819-153-2-201007200-02003
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Published: Ann Intern Med. 2010;153(2):JC1-3.
Chronic Obstructive Airway Disease, Prevention/Screening, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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