Inhaled corticosteroid use in asthma and the prevention of myocardial infarction

doi:10.1016/S0002-9343(03)00393-0

The American Journal of Medicine

Volume 115, Issue 5, 1 October 2003, Pages 377-381

https://doi.org/10.1016/S0002-9343(03)00393-0 Get rights and content

Abstract

Background

Asthma patients may be at increased risk of cardiovascular outcomes due to hypoxemia from asthma exacerbations and bronchodilator-induced tachycardia. We investigated whether inhaled corticosteroids, which are known to improve asthma control and reduce exacerbations, are associated with a lower rate of myocardial infarction.

Methods

We used the Saskatchewan Health databases to form a population-based cohort of subjects aged 5 to 44 years who were using antiasthma drugs between 1975 and 1991. Subjects were followed until 1997, the age of 55 years, or death. A nested case-control approach was used where each subject with a first myocardial infarction was matched on calendar time, age, and sex with up to 10 controls randomly selected from the cohort.

Results

The cohort consisted of 30,569 subjects, including 105 patients with myocardial infarction who were matched with 933 controls. The adjusted rate ratio of myocardial infarction for inhaled corticosteroid use during the year before the index date was 0.56 (95% confidence interval [CI]: 0.32 to 0.99) as compared with no use. Myocardial infarction decreased by 12% (95% CI: 0% to 23%) with each additional canister used during this 1-year period. The rate ratio of myocardial infarction for inhaled corticosteroid use was 0.78 (95% CI: 0.41 to 1.51) among patients with milder asthma and 0.19 (95% CI: 0.04 to 0.97) among those with more severe asthma.

Conclusion

Inhaled corticosteroid use may reduce the risk of myocardial infarction in asthma patients, particularly those with more severe disease.

Section snippets

Subjects

The cohort of asthma patients 8, 9, 10 was derived from the databases of Saskatchewan Health, a universal health insurance program provided to the residents of the province of Saskatchewan. The databases have been used to study the effects of several prescription drugs (11). To date, more than 2 million people have been covered by this program. We selected all 30,569 beneficiaries aged between 5 and 44 years who received at least three prescriptions for an antiasthma medication in any 1-year

Results

A total of 562 deaths were identified from the cohort, of which 23 were classified as deaths resulting from myocardial infarction. We also found 107 subjects who were hospitalized for myocardial infarction during the follow-up. However, because 11 of the 23 patients with fatal myocardial infarction had been previously hospitalized for myocardial infarction, a total of 119 cases of a first myocardial infarction remained, of which only 12 were fatal. The cohort of 30,569 asthma patients was

Discussion

We found that inhaled corticosteroid use is associated with a decrease in the risk of myocardial infarction in patients with asthma. After adjusting for the concurrent use of beta-agonists and theophylline, the severity of asthma, and risk factors for myocardial infarction, our data suggest that regular use of inhaled corticosteroids in patients with asthma reduces the risk of myocardial infarction by 50%.

The beneficial effect of inhaled corticosteroids is most likely a result of improved

Acknowledgements

We would like to thank Mary Rose Stang for her assistance in compiling the data.

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^☆

This study was funded by a grant from the Canadian Institutes of Health Research of Canada. The data were acquired thanks to grants from AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, and Schering-Plough. Dr. Suissa is a recipient of a Distinguished Senior Scientist award from the Canadian Institutes of Health Research of Canada. Dr. Assimes was a recipient of a training bursary from the Fonds de la Recherche en Santé du Québec during the study. The McGill Pharmacoepidemiology Research Unit is funded by an infrastructure grant from the Fonds de la Recherche en Santé du Québec.

This study is based on de-identified data provided by the Saskatchewan Department of Health. The interpretation and conclusions contained herein do not necessarily represent those of the government of Saskatchewan or the Saskatchewan Department of Health.

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Clinical studyInhaled corticosteroid use in asthma and the prevention of myocardial infarction☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Subjects

Results

Discussion

Acknowledgements

Ultrasound Med Biol

Atherosclerosis

Gen Pharmacol

Med Clin North Am

Lancet

Chest

Chest

Intravascular hemodynamic factors responsible for progression of coronary atherosclerosis and development of vulnerable plaque

Curr Opin Cardiol

Effects of sympathetic activation by adrenergic infusions on hemostasis in vivo

Eur J Haematol

Mechanisms of platelet aggregation

Curr Opin Hematol

Bronchodilators and acute cardiac death

Am J Respir Crit Care Med

Chronic obstructive pulmonary disease

N Engl J Med

Low-dose inhaled corticosteroids and the prevention of death from asthma

N Engl J Med

Clinical study
Inhaled corticosteroid use in asthma and the prevention of myocardial infarction☆