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Title: Anticholinergics May Increase Risk of Cardiovascular Death, MI, or Stroke in COPD Patients
URL: http://www.pslgroup.com/dg/22D712.htm
Doctor's Guide
September 24, 2008

CHICAGO -- September 24, 2008 -- The use of inhaled anticholinergic agents by patients with chronic obstructive pulmonary disease (COPD) is associated with a significantly increased risk of heart attack, stroke, or cardiovascular death, according to a meta-analysis of randomised trials published in the September 24 issue of the Journal of the American Medical Association.

Sonal Singh, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and colleagues conducted a meta-analysis to determine cardiovascular risks associated with the long-term use of inhaled anticholinergics.

After identifying and a detailed screening of 103 articles, 17 randomised trials enrolling 14,783 patients were analysed. Follow-up duration ranged from 6 weeks to 5 years.

The analysis indicated that inhaled anticholinergics significantly increased the risk, by 58%, of cardiovascular death, heart attack, or stroke (1.8% vs 1.2% for controls). Among individual components of the primary outcome, inhaled anticholinergics significantly increased the risk of heart attack by 53% (1.2% vs 0.8%) and also significantly increased the risk of cardiovascular death by 80% (0.9% vs 0.5%).

All-cause death was reported in 149 of the patients treated with inhaled anticholinergics (2.0%) and in 115 of the control patients (1.6%). A sensitivity analysis restricted to 5 long-term trials (>6 months) confirmed the significantly increased risk (73%) of cardiovascular death, heart attack, or stroke (2.9% of patients treated with anticholinergics vs 1.8% of controls).

"Chronic obstructive pulmonary disease is an independent risk factor for cardiovascular hospitalisation and cardiovascular death. Cardiovascular death is a more frequent cause of death in patients with COPD than respiratory causes, with the proportion of cardiovascular deaths increasing with the severity of the disease," the authors write.

"Clinicians need to closely monitor patients with COPD who are taking long-term anticholinergics for the development of cardiovascular events. Clinicians and patients should carefully consider these potential long-term cardiovascular risks of inhaled anticholinergics in the treatment of COPD and decide whether these risks are an acceptable trade-off in return for their symptomatic benefits."


SOURCE: Journal of the American Medical Association

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