Abstract
Background: A recent study found that short acting ß agonists used in the treatment of asthma and chronic obstructive pulmonary disease (COPD) may increase the risk of acute myocardial infarction. We investigated this hypothesis in patients with COPD already at high risk of cardiac disease.
Methods: The Saskatchewan Health Services databases were used to form a population based cohort of all patients newly diagnosed with COPD over the age of 55 years identified between 1980 and 1997. All subjects were followed up until 1999, death, or the first occurrence of acute myocardial infarction. Those with a first acute myocardial infarction, fatal or non-fatal, were matched on calendar time and age with cohort members.
Results: The cohort consisted of 12 090 subjects including 1127 cases with fatal or non-fatal acute myocardial infarction. The adjusted rate ratio for current use of inhaled ß agonists was 1.12 (95% confidence interval (CI) 0.95 to 1.33), and for first time use it was 1.02 (95% CI 0.52 to 2.00). There was also no significant increase in risk when the analysis was restricted to subjects with cardiac risk factors such as hypertension and diabetes, or to subjects not having been prescribed ß blocker medications.
Conclusion: Short acting inhaled ß agonist use among patients with COPD does not appear to increase the risk of fatal or non-fatal acute myocardial infarction.
Full Text
The Full Text of this article is available as a PDF (107.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Au D. H., Lemaitre R. N., Curtis J. R., Smith N. L., Psaty B. M. The risk of myocardial infarction associated with inhaled beta-adrenoceptor agonists. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):827–830. doi: 10.1164/ajrccm.161.3.9904006. [DOI] [PubMed] [Google Scholar]
- Burgess C. D., Flatt A., Siebers R., Crane J., Beasley R., Purdie G. A comparison of the extent and duration of hypokalaemia following three nebulized beta 2-adrenoceptor agonists. Eur J Clin Pharmacol. 1989;36(4):415–417. doi: 10.1007/BF00558306. [DOI] [PubMed] [Google Scholar]
- Hole D. J., Watt G. C., Davey-Smith G., Hart C. L., Gillis C. R., Hawthorne V. M. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996 Sep 21;313(7059):711–716. doi: 10.1136/bmj.313.7059.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kiely D. G., Cargill R. I., Grove A., Struthers A. D., Lipworth B. J. Abnormal myocardial repolarisation in response to hypoxaemia and fenoterol. Thorax. 1995 Oct;50(10):1062–1066. doi: 10.1136/thx.50.10.1062. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lipworth B. J. Risks versus benefits of inhaled beta 2-agonists in the management of asthma. Drug Saf. 1992 Jan-Feb;7(1):54–70. doi: 10.2165/00002018-199207010-00007. [DOI] [PubMed] [Google Scholar]
- Maesen F. P., Costongs R., Smeets J. J., Brombacher P. J., Zweers P. G. The effect of maximal doses of formoterol and salbutamol from a metered dose inhaler on pulse rates, ECG, and serum potassium concentrations. Chest. 1991 Jun;99(6):1367–1373. doi: 10.1378/chest.99.6.1367. [DOI] [PubMed] [Google Scholar]
- Rawson N. S., Malcolm E. Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles. Stat Med. 1995 Dec 30;14(24):2627–2643. doi: 10.1002/sim.4780142404. [DOI] [PubMed] [Google Scholar]
- Suissa S., Hemmelgarn B., Blais L., Ernst P. Bronchodilators and acute cardiac death. Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 1):1598–1602. doi: 10.1164/ajrccm.154.6.8970341. [DOI] [PubMed] [Google Scholar]