Tiotropium may decrease cardiovascular risk in COPD patients

January 01, 0001

Tiotropium may decrease cardiovascular risk in COPD patients

There has been growing evidence of increased cardiovascular risk with ipratropium use. This group of European and American authors mined the recently updated clinical trial safety database for tiotropium to get a better characterization of its cardiovascular risk. They utilized randomized, double-blind, parallel-group, placebo-controlled trials lasting 4 or more weeks. Adverse events data were collected throughout each trial. Incidence rates (IRs) were calculated based on total time at risk. IRs were determined for all-cause mortality and a composite CV end point of CV deaths, nonfatal myocardial infarction (MI), nonfatal stroke, and sudden cardiac death.

The authors found: "There were 19,545 patients randomized-10,846 (tiotropium) and 8,699 (placebo) from 30 trials. Mean FEV1 = 1.15 L (41% of predicted), 76 percent men, mean age = 65. Cumulative exposure to study drug was 13,146 (tiotropium) and 11,095 (placebo) patient-years. For all-cause mortality, the IR was 3.44 (tiotropium) and 4.10 (placebo) per 100 patient- years (RR = 0.88). IR for the CV end point was 2.15 (tiotropium) and 2.67 (placebo) per 100 patient-years (RR = 0.83). The IR for the CV mortality excluding nonfatal MI and stroke was 0.91 (tiotropium) and 1.24 (placebo) per 100 patient-years (RR = 0.77). For total MI, cardiac failure, and stroke the RRs were 0.78, 0.82, and 1.03, respectively."

The authors concluded: "Tiotropium was associated with a reduction in the risk of all-cause mortality, CV mortality, and CV events."

This study gives reassurance of the safety of tiotropium, and even suggests it may reduce cardiovascular risk.

For the full abstract, click here.

Chest 137(1):20-30, January 2010
© 2010 to the American College of Chest Physicians
Cardiovascular Safety of Tiotropium in Patients With COPD. Bartolome Celli, Marc Decramer, Inge Leimer, Ulrich Vogel, Steven Kesten, and Donald P. Tashkin. Correspondence to Bartolome Celli: [email protected]

Category: K. Circulatory, R. Respiratory. Keywords: tiotropium, cardiovascular risk, COPD, mortality, myocardial infarction, meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 5 March 2010

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