JAMA Int Med：长效支气管扩张剂与心血管事件风险升高相关

　　加拿大一项研究表明，慢性阻塞性肺疾病（COPD）常用治疗药物长效β受体激动剂（LABA）和长效抗胆碱能药物与心血管事件风险升高具有相关性。论文5月21日在线发表于《美国医学会杂志·内科学》（JAMA  Internal Medicine）。

　　此项研究通过医疗保健数据库确认了191000余例接受5年以上COPD治疗的66岁以上患者。28%（53,532例）的患者因急性冠脉综合征（ACS）、心衰、缺血性卒中或心律失常而急诊入院。对所有COPD患者与非COPD患者进行匹配后加以分析。

　　结果显示，LABA和长效抗胆碱能药物在启用后2～3周内事件风险最高，并且药物之间无差异。新开具LABA和长效抗胆碱能药物与心血管事件风险升高31%相关。对心血管终点进行单独评估时，ACS和心衰风险升高，但心律失常和卒中并非如此。实际上，长效抗胆碱能药物对缺血性卒中有保护作用，LABA则无此效应。

　　多位相关专家评论该研究时表示，由于LABA和长效抗胆碱能药物均为COPD的主要治疗药物，并且无其他药物可延缓疾病进展，因此需对应用长效支气管扩张剂的患者进行密切监测。

　　长效支气管扩张剂与心血管事件之间的关系在POET-COPD随机对照研究以及之前的一项小型研究得到证实，正在进行的TIOSPIR安全性研究或许可解释不同COPD治疗药物的相对风险。

Inhaled long-acting bronchodilators in COPD flagged again for CV hazard
Two commonly used drugs used in the treatment of chronic obstructive pulmonary disease (COPD) are associated with an increased risk of cardiovascular events, a new review concludes [1]. The study, published online May 21, 2013 in JAMA Internal Medicine, found that both inhaled long-acting beta-agonist (LABA) and long-acting anticholinergic drugs, when newly prescribed, were associated with a 31% increased risk of a CV event, when compared with nonprescription of these agents.
Dr Andrea Gershon (Institute for Clinical Sciences, Toronto, ON) and colleagues reviewed healthcare databases in Ontario identifying over 191 000 patients age >66 years treated for COPD over a five-year period. Of these, they noted, 53 532, or 28%, were hospitalized or admitted to an emergency department for ACS, heart failure, ischemic stroke, or cardiac arrhythmia. For the analysis, all COPD patients were matched with non-COPD patients.
Risk of events with both agents appeared to be highest within the first two or three weeks of starting the medication, and there were no differences between medications, Gershon et al write. When the individual cardiovascular end points were examined separately, the authors found that risk appeared to be increased for ACS and heart failure, but not for arrhythmias or stroke. In fact, a protective effect was seen for new long-acting anticholinergic agents for ischemic stroke, but not for new LABA prescription...