Chest
Clinical InvestigationsCardiologyAssociation Between Inhaled β-Agonists and the Risk of Unstable Angina and Myocardial Infarction
Section snippets
Materials and Methods
The data for this study were collected as part of the Ambulatory Care Quality Improvement Project (ACQUIP). ACQUIP was a multicenter, randomized, clinical trial designed to test whether monitoring patients’ self-reported health and provision of regular reports to primary-care clinicians improves clinical outcomes and patients’ satisfaction. This study included those subjects who were enrolled in ACQUIP from December 1996 through May 1999. The study was clinic based and sought to enroll all
Results
We identified a total of 10,569 case patients and control subjects who had been sent a baseline health checklist questionnaire. Of these, 6,463 individuals (61%) had returned the health checklist questionnaire and had provided complete information. As expected, case patients and control subjects differed in a number of cardiovascular risk factors, including age, hypertension, number of pack-years smoked, and diabetes (Table 1). In addition, the prevalence of cardiovascular disease was
Discussion
We found that patients hospitalized for myocardial infarction or unstable angina were significantly more likely than control subjects to have received a β-agonist MDI during the 3 months immediately prior to their index date. We observed a dose-response relationship that did not appear to be confounded by tobacco use, COPD history, cardiovascular disease, or cardiovascular risk factors. Furthermore, the increased risk of an acute coronary syndrome was highest in those subjects who had not been
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2019, Respiratory MedicineCitation Excerpt :Excessive stimulation of β-adrenoceptors increases heart rate and myocardial oxygen demand, and causes direct myocardial injury or necrosis that could lead to ischemia [12]. A number of observational studies have suggested an association between the initiation of inhaled β2-agonist therapy with increased risk of acute myocardial infarction [13,14]. However, Rossinen et al. [15] performed a trial of the influence of inhaled salbutamol on myocardial ischemia as assessed by Holter monitoring, in 24 patients with coronary artery disease and clinically stable asthma or COPD; they observed that myocardial ischemia, remained unaltered with doses of salbutamol of up to 5 mg.
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Funding for this project was provided through the Department of Veterans Affairs and Health Services Research and Development, SDR96-002, Ambulatory Care Quality Improvement Project.
Dr. Au is supported by a Health Services Research and Development Fellowship from the Department of Veteran Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veteran Affairs.