Association between inhaled β-agonists and the risk of unstable angina and myocardial infarction
Association between inhaled β-agonists and the risk of unstable angina and myocardial infarction
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DOI：
10.1378/chest.121.3.846
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发表时间：
2002-03-01
期刊：
影响因子：
9.6
通讯作者：
Fihn, SD
中科院分区：
文献类型：
--
作者：
Au, DH;Curtis, JR;Fihn, SD
背景资料：β-肾上腺素受体激动剂（β-激动剂）通常用于治疗阻塞性肺病，初步研究表明，它们与不良心血管结局的风险增加有关。我们进一步研究了急性冠脉综合征和吸入性β-受体激动剂therapy.Methods之间的关系：我们进行了巢式病例对照研究，收集的数据是作为一个更大的，正在进行的，前瞻性研究的质量改善的初级保健诊所的七个退伍军人管理局医疗中心。我们确定了1996年至1999年间住院的630例不稳定型心绞痛或急性心肌梗死患者。我们根据诊所位置将这些病例患者与10,486名对照受试者进行频率匹配，并随机分配每个“索引日期”。“每个中心的计算机化药房数据库用于确定β-激动剂的使用。心血管危险因素进行了评估，从邮寄的问卷调查和电子病历，其中包括住院和门诊诊断，药物治疗，和实验室检查结果。结果：在比较的患者谁没有填写β-激动剂处方在90天之前，他们的索引日期，谁填写了β-激动剂处方的患者有增加的风险经历急性冠状动脉综合征。在调整年龄和心血管危险因素（包括高血压、糖尿病和吸烟史）后，急性冠脉综合征的风险增加持续存在。此外，对于1至2个计量吸入器（MDI）罐，存在剂量-反应关系，调整后比值比（OR）为1.38（95%置信区间[CI]，0.86 - 2.23），3 - 5个MDI罐的OR为1.57（95% CI，1.01 - 2.46），6个或更多MDI罐的OR为1.93（95% CI，1.23 - 3.03）。在接受β受体阻滞剂处方分层后，未接受β受体阻滞剂的受试者中1 - 2个MDI罐的校正OR为1.55（95% CI，0.60 - 3.99），3 - 5个储液罐的OR为4.07（95% CI，2.17 - 7.64），6个或更多储液罐的OR为3.83（95% CI，2.02 - 7.29）。受试者谁收到了β受体阻滞剂和β受体激动剂没有增加急性冠状动脉综合征的风险，除非他们，已经填补了6个或更多的β受体激动剂MDI canisters.Conclusions：吸入β受体激动剂的处方可能会增加COPD患者心肌梗死和不稳定型心绞痛的风险。
Background: Beta-Adrenoceptor agonists (beta-agonists) are commonly, used to treat obstructive lung diseases, and preliminary studies have suggested they are associated with an increased risk of adverse cardiovascular outcomes. We further examined the association between acute coronary, syndromes and inhaled beta-agonist therapy.Methods: We performed a nested, case-control study using data that were collected as part of a larger, ongoing, prospective study of quality improvement in the primary care clinics of seven Veterans Administration Medical Centers. We identified 630 patients with unstable angina or acute myocardial infarction hospitalized between 1996 and 1999. We frequency matched these case patients to 10,486 control subjects according to clinic location, and randomly assigned each an "index date." The computerized pharmacy database at each center was used to ascertain beta-agonist use. Cardiovascular risk factors were assessed from mailed questionnaires and electronic medical records, which included inpatient and outpatient diagnoses, medications, and laboratory results.Results: In comparison with patients who had not filled a beta-agonist prescription during the 90 days prior to their index date, patients who had filled a beta-agonist prescription had an increased risk of experiencing an acute coronary syndrome. The increased risk of an acute coronary syndrome persisted after adjusting for age and cardiovascular risk factors, including hypertension, diabetes, and smoking history. Moreover, there was a dose-response relationship with an adjusted odds ratio (OR) of 1.38 for one to two metered-dose inhaler (MDI) canisters (95% confidence interval [CI], 0.86 to 2.23), an OR of 1.57 for three to five MDI canisters (95% CI, 1.01 to 2.46), and an OR of 1.93 for six or more MDI canisters (95% CI, 1.23 to 3.03). After stratifying for receipt of a beta-blocker prescription, the adjusted OR in subjects who did not receive a beta-blocker was 1.55 for one to two MDI canisters (95% CI, 0.60 to 3.99), an OR of 4.07 for three to five canisters (95% Cl, 2.17 to 7.64), and an OR of 3.83 for six or more canisters (95% Cl, 2.02 to 7.29). Subjects who had received both beta-blockers and beta-agonists had no increase in risk in acute coronary syndromes unless they, had filled six or more beta-agonist MDI canisters.Conclusions: A prescription for inhaled beta-agonists may increase the risk of myocardial infarction and unstable angina in patients with COPD.