Article date: April 2008
By: Frank De Vries, Sander Pouwels, Madelon Bracke, Jan‐Willem Lammers, Olaf Klungel, Hubert Leufkens, Tjeerd Van Staa, in Volume 65, Issue 4, pages 580-586
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Use of β2 agonists has been associated with tachycardia, an abnormal ECG and atrial fibrillation.
• Previous observational studies of the association between use of β2 agonists and the risk of acute myocardial infarction (MI) have demonstrated conflicting results.
• Instead of a causal effect, the positive association between β2 agonist use and MI may be explained by latent ischaemic heart disease, which has symptoms that appear similar to respiratory complaints in chronic obstructive pulmonary disease.
WHAT THIS STUDY ADDS
• The majority of β2 agonist users in our study population did not have an increased risk of nonfatal acute MI.
• Only patients with ischaemic heart disease and who had recently started β2 agonists had an increased risk of acute MI.
• It is likely that this increased risk was related to latent cardiovascular disease rather than direct effects of β2 agonists.
AIM Observational retrospective studies of the association between use of β2 agonists and the risk of acute myocardial infarction (MI) have demonstrated conflicting results, particularly among first‐time users. The aim of this study was to examine the association between β2 agonist use and first nonfatal acute MI.
METHODS We conducted a case–control study (2476 cases) nested in a cohort of antihypertensive drug users in the Dutch PHARMO RLS database. PHARMO RLS consists of drug dispensing linked to the national hospitalizations register. Each case of nonfatal acute MI was matched with up to 12 control patients by gender, age and region. Drug and disease history and the severity of the underlying respiratory disease were adjusted for.
RESULTS Risk of acute MI was increased in current β2 agonist users [crude odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61]. However, this excess risk was reduced after adjustment for severity of asthma and chronic obstructive pulmonary disease (adjusted OR 1.18, 95% CI 0.93, 1.49). The risk was highest in patients with ischaemic heart disease and low cumulative dose of β2 agonists (adjusted OR 2.47, 95% CI 1.60, 3.82).
CONCLUSION Most users of β2 agonists did not have an increased risk of acute MI. Only patients with ischaemic heart disease with low cumulative exposure to β2 agonists had an increased risk of acute MI. It is likely that this increased risk was related to latent cardiovascular disease rather than to the direct effects of β2 agonists.
DOI: 10.1111/j.1365-2125.2007.03077.x
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