Figures
- Fig. 1—
Fitted rate ratio (RR) for acute myocardial infarction as a function of the average daily dose of inhaled corticosteroids (ICS) in the 12 months prior to index date. Adjusted for age and duration of chronic obstructive pulmonary disease (COPD; by study design), and for the dose of oral corticosteroids, sex, number of prescriptions of bronchodilators in the last 12 months (none, 1–12, >12), number of COPD exacerbations, hospitalisation in the last 3 months, diabetes, systemic hypertension, ischaemic heart disease and heart failure.
Tables
- Table. 1—
Characteristics of the study subjects
Characteristics Cases Controls# Subjects n 371 1864 Mean age yrs 77.7±8.6 77.7±3.8 Males 243 (65.5) 949 (50.8) Duration of follow-up yrs 2.5±2.2 2.6±1.0 Medical characteristics at cohort entry Diabetes 60 (16.2) 128 (7.0) Systemic hypertension 244 (65.8) 940 (52.2) Hyperlipidaemia 16 (4.3) 59 (3.4) Ischaemic heart disease 155 (41.8) 332 (18.1) Heart failure 104 (28.0) 252 (13.7) COPD co-therapy¶ Prescriptions for inhaled β-agonists</emph> 2.2±3.6 2.0±1.5 Prescriptions for inhaled ipratropium 1.5±3.1 1.3±1.4 Prescriptions for nebulised β-agonists 1.4±4.1 1.2±2.1 Prescriptions for theophylline 0.9±2.7 0.9±1.2 Daily dose of oral corticosteroids mg hydrocortisone 3.7±11.2 2.3±3.1 COPD exacerbations+ prior to index date 0 248 (66.9) 1320 (71) 1–2 84 (22.6) 411 (21.8) ≥3 39 (10.5) 133 (7.2) Hospitalisation in the last 3 months days None 261 (70.4) 1683 (90.3) <7 61 (16.4) 75 (4.1) 7–13 28 (7.6) 66 (3.6) ≥14 21 (5.7) 40 (2.0) Aspirin at low dose 38 (10.2) 116 (6.6) Other nonsteroidal anti-inflammatory agents 91 (24.5) 411 (22.3) Data are presented as mean±sd or n (%). COPD: chronic obstructive pulmonary disease. #: to account for the variable number of controls in each matched set, all means, sd and percentages were weighted by the inverse of the number of controls in each set; ¶: in the 12 months before index date; +: defined as the number of hospitalisations with COPD as the primary discharge diagnosis and the number of times where, within a 7-day time-window, antibiotics and corticosteroids were simultaneously prescribed.
- Table. 2—
Matched crude and adjusted rate ratios (RR) for acute myocardial infarction (AMI) in relation to the use of inhaled corticosteroids during the 1yr period before index date#
Case Controls¶ Crude RR Adjusted RR+ Subjects n 371 1864 Exposure in the last 12 months None 214 (57.7) 1000 (54.3) 1 (ref. group) 1 (ref. group) Any use 157 (42.3) 864 (45.7) 0.86 (0.68–1.09) 0.83 (0.63–1.08) Current exposure# 71 (19.1) 359 (18.7) 0.95 (0.70–1.28) 0.82 (0.57–1.16) Past exposure# 86 (23.2) 505 (27.1) 0.80 (0.60–1.06) 0.83 (0.61–1.14) Data are presented as n (%) or RR (95% confidence interval), unless otherwise stated. ref.: reference. #: the index date for case subjects and matched controls was the date of the case subject AMI; ¶: to account for the variable number of controls in each matched set, all means, sd and percentages were weighted by the inverse of the number of controls in each set; +: adjusted for age and duration of chronic obstructive pulmonary disease (COPD; by study design), and for sex, number of COPD exacerbations, number of prescriptions of bronchodilators in the last 12 months (none, 1–12, >12), oral corticosteroid dose dispensed in the last 12 months, hospitalisation in the last 3 months, diabetes, systemic hypertension, ischaemic heart disease and heart failure.
- Table. 3—
Matched crude and adjusted rate ratios (RR) for acute myocardial infarction in relation to the quantity of inhaled corticosteroids dispensed in the prior year
Case Controls# Crude RR Adjusted RR¶ Subjects n 371 1864 No exposure in the last 12 months 214 (57.7) 1000 (54.3) 1 (ref. group) 1 (ref. group) Average daily dose in the last 12 months beclomethasone-equivalent units ≤50 µg·day−1 19 (5.1) 123 (6.3) 0.74 (0.44–1.24) 0.82 (0.48–1.42) 50–200 µg·day−1 47 (12.7) 322 (17.6) 0.68 (0.48–0.97) 0.68 (0.47–0.99) 200–500 µg·day−1 39 (10.5) 199 (10.6) 0.92 (0.63–1.34) 0.84 (0.55–1.29) >500 µg·day−1 52 (14.0) 220 (11.3) 1.15 (0.81–1.63) 1.07 (0.71–1.60) Data are presented as n (%) or RR (95% confidence interval), unless otherwise stated. ref.: reference. #: to account for the variable number of controls in each matched set, all means, sd and percentages were weighted by the inverse of the number of controls in each set; ¶: adjusted for age and duration of chronic obstructive pulmonary disease (COPD; by study design), and for sex, number of COPD exacerbations, number of prescriptions of bronchodilators in the last 12 months (none, 1–12, >12), oral corticosteroid dose dispensed in the last 12 months, hospitalisation in the last 3 months, diabetes, systemic hypertension, ischaemic heart disease and heart failure.
- Table. 4—
Matched crude and adjusted rate ratios (RR) for acute myocardial infarction in relation to the duration of inhaled corticosteroid use
Case Controls# Crude RR Adjusted RR¶ Subjects n 371 1864 No exposure in the last 12 months 214 (57.7) 1000 (54.3) 1 (ref. group) 1 (ref. group) Currently exposed 1–30 days 25 (6.7) 130 (6.8) 0.92 (0.58–1.45) 0.78 (0.47–1.30) 31–60 days 19 (5.1) 58 (3.1) 1.53 (0.88–2.65) 1.17 (0.64–2.16) >61 days 27 (7.3) 171 (8.8) 0.77 (0.49–1.19) 0.70 (0.43–1.15) Duration months 3.1±5.1 4.7±3.3 0.97 (0.93–1.01)+ Data are presented as n (%), mean±sd or RR (95% confidence interval), unless otherwise stated. ref.: reference. #: to account for the variable number of controls in each matched set, all means, sd and percentages were weighted by the inverse of the number of controls in each set; ¶: adjusted for age and duration of chronic obstructive pulmonary disease (COPD; by study design), and for sex, number of COPD exacerbations, number of prescriptions of bronchodilators in the last 12 months (none, 1–12, >12), oral corticosteroid dose dispensed in the last 12 months, hospitalisation in the last 3 months, diabetes, systemic hypertension, ischaemic heart disease, and heart failure; +: associated with an increase of 1 month of continuous exposure.
