Abstract 13125: Long Term Use of Inhaled Anticholinergic Agents in Chronic Obstructive Pulmonary Disease Patients Does Not Increase the Risk of Cardiovascular Events: A Meta-analysis of Randomized Controlled Trials
Background: Anticholinergic drugs have been the mainstay therapy for chronic obstructive pulmonary disease (COPD), both for acute management and maintenance therapy. Recent clinical trials have raised concerns about the cardiovascular safety of these agents. Subsequent meta-analyses addressing this association have produced conflicting Results, especially when the results have been extrapolated over time. We therefore conducted a systematic review and updated meta-analysis of randomized controlled trials evaluating the long term cardiovascular safety of anticholinergics as compared to placebo in patients with COPD.
Methods: A total of 13,500 patients from 7 randomized placebo-controlled clinical trials were analyzed by using the Comprehensive Meta-Analysis software. The Mantel-Haenszel fixed-effect model was used to calculate combined relative risks for those outcomes the studies were homogenous and the random effect model was used when the studies were heterogenic. A two-sided alpha error of < 0.05 was considered to be statistically significant.
Results: After a long term follow up of one year, usage of anticholinergics did not significantly increase the risk of all cause mortality (p=0.99) or cardiovascular mortality (p=0.42), when compared to placebo. Also, the incidence of myocardial infarction (p=0.65), stroke (p=0.60) or any major cardiovascular event (p=0.20) did not differ among the two groups. In all the trials, patients on anticholinergics had significant improvement in lung function at the end of one year, when compared to those on placebo.
Conclusion: In patients with COPD, long term use of inhaled anticholinergic agents has no significant effect on mortality or the occurrence of adverse cardiovascular events. However, to better understand the association, further evaluation in a large randomized controlled trial is warranted.
- © 2010 by American Heart Association, Inc.