{"id":16,"date":"2009-01-17T16:35:55","date_gmt":"2009-01-17T15:35:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=16"},"modified":"2015-11-12T13:15:43","modified_gmt":"2015-11-12T12:15:43","slug":"anticholinergics-increase-risk-of-cardiovascular-disease","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2009\/01\/17\/anticholinergics-increase-risk-of-cardiovascular-disease\/","title":{"rendered":"Anticholinergics increase risk of cardiovascular death"},"content":{"rendered":"<p style=\"text-align: justify\">Inhaled anticholinergics &#8211; such as ipratropium or tiotropium bromide &#8211; are commonly prescribed to patients with chronic obstructive pulmonary disease (COPD).\u00a0 A previous analysis of 19 short-term placebo-controlled trials had suggested a possible increased risk of stroke with inhaled tiotropium, therefore Singh et al. performed a meta-analysis of 17 trials enrolling 14783 patients in order to ascertain the cardiovascular risks of inhaled anticholinergics.<!--more--><\/p>\n<p>Follow up duration ranged from 6 weeks to 5 years.\u00a0 Cardiovascular death, myocardial infarction, or stroke occurred in 135 of 7472 patients (1.8%) receiving inhaled anticholinergics and 86 of 7311 patients (1.2%) receiving control therapy (relative risk, 1.58); p&lt;0.001).\u00a0 Specifically, anticholinergic therapy significantly increased the risk of myocardial infarction (relative risk, 1.53, p=.03) and cardiovascular death (relative risk, 1.80, p=.008) without a significant increase in the risk of stroke (relative risk, 1.46, p=.20).\u00a0 All-cause mortality was reported in 149 of the patients taking anti-cholinergics (2.0%) and 115 of the control patients (1.6%, relative risk 1.26, p=.06), and a sensitivity analysis restricted to only the long-term trials confirmed the increased risk of cardiovascular death, myocardial infarction, or stroke (2.9% vs. 1.8%; p&lt;0.001).<\/p>\n<p>Most of the excess risk was found to come when anticholinergics were taken for at least six months.\u00a0 Although the risk of cardiovascular death increased by some 80%, anticholinergics can cause a significant improvement in symptoms of breathlessness in COPD patients.\u00a0 As a result, any risk associated with their use may still remain acceptable to some patients.\u00a0 Furhter information on this risk should be obtained from the upcoming UPLIFT (Understanding Potential Long-Term Impacts on Function with Tiotropium) study.<\/p>\n<ul>\n<li><strong>Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease. A systematic review and meta-analysis. JAMA 2008; 300:1439-1450.<\/strong><\/li>\n<\/ul>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Inhaled anticholinergics &#8211; such as ipratropium or tiotropium bromide &#8211; are commonly prescribed to patients with chronic obstructive pulmonary disease (COPD).\u00a0 A previous analysis of 19 short-term placebo-controlled trials had suggested a possible increased risk of stroke with inhaled tiotropium, therefore Singh et al. performed a meta-analysis of 17 trials enrolling 14783 patients in order [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2009\/01\/17\/anticholinergics-increase-risk-of-cardiovascular-disease\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":47,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[279],"tags":[494,491,492,493],"class_list":["post-16","post","type-post","status-publish","format-standard","hentry","category-general-cardiology","tag-anticholinergics","tag-copd","tag-inhalers","tag-ipratropium"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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