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JAMA Intern Med:长效吸入性支气管扩张剂或增加COPD患者心血管风险

2013-08-27 佚名 环球医学编译

题目:慢性阻塞性肺疾病的患者吸入长效支气管扩张剂的心血管安全性(Cardiovascular Safety of Inhaled Long-Acting Bronchodilators in Individuals With Chronic Obstructive Pulmonary Disease) 重要性:慢性阻塞性肺疾病(COPD)是一种常见的致命性疾病。长效吸入性β-受体激动剂和

题目:

慢性阻塞性肺疾病的患者吸入长效支气管扩张剂的心血管安全性(Cardiovascular Safety of Inhaled Long-Acting Bronchodilators in Individuals With Chronic Obstructive Pulmonary Disease)

重要性:

慢性阻塞性肺疾病(COPD)是一种常见的致命性疾病。长效吸入性β-受体激动剂和抗胆碱药是治疗慢性阻塞性肺病的一线药物,与心血管结局的风险增加相关。当进行药物选择时,患者和医生应该明了其最小风险,并从中获益。【原文下载

目的:

评估这些典型药物与心血管事件住院和急诊风险的相关性。

设计:

我们对一项回顾性队列研究进行了巢式病例对照分析。在匹配和调整预后因素后,对新处方长效吸入性β-受体激动剂和抗胆碱能药物两个患者组之间的事件风险进行了比较。

地点:

加拿大最大省安大略省的医疗保健数据库中近13万的来自多元文化的人群。

受试者:

在卫生管理数据的基础上,纳入确诊为COPD,并在2003年9月1日~2009年3月31日间接受治疗的年龄≥66岁的患者。

暴露:

新实用长效吸入性β-激动剂或长效抗胆碱能。

主要结局和测量:

因心血管事件导致的急诊或住院。

结果:

在符合条件的191005例患者中,53532例(28.0%)患者因心血管事件而住院或急诊。新处方的长效吸入性β-受体激动剂和抗胆碱能药物的患者与不使用这些药物的患者相比,其与事件风险较高相关(调整比值比为1.31 [95%CI,1.12~1.52,P <0.001]和1.14 [95%CI,1.01~1.28,P=0.03)。我们发现两种药物间的事件无显著差异(长效吸入性β-受体激动剂vs抗胆碱药的调整后比值比:1.15 [95%CI,0.95~1.38,P=0.16])。

结论与相关性:

在老年COPD患者中,新使用长效吸入性β-受体激动剂和抗胆碱药与类似的心血管事件风险增加相关。需要对使用长效支气管扩张剂的COPD患者进行密切监测。

原始出处:

Gershon A, Croxford R, Calzavara A, To T, Stanbrook MB, Upshur R, Stukel TA.Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease.JAMA Intern Med. 2013 Jul 8;173(13):1175-85. doi: 10.1001/jamainternmed.2013.1016. 【原文下载

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    2014-02-19 lsj637
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    2013-08-29 gous
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