PMID- 31114181
OWN - NLM
STAT- MEDLINE
DCOM- 20191219
LR  - 20200225
IS  - 1178-2005 (Electronic)
IS  - 1176-9106 (Print)
IS  - 1176-9106 (Linking)
VI  - 14
DP  - 2019
TI  - Relationship of inhaled long-acting bronchodilators with cardiovascular outcomes 
      among patients with stable COPD: a meta-analysis and systematic review of 43 
      randomized trials.
PG  - 799-808
LID - 10.2147/COPD.S198288 [doi]
AB  - Background: Long-acting muscarinic antagonists (LAMAs) and long-acting 
      beta2-agonists (LABAs) are the mainstay of maintenance therapy for chronic 
      obstructive pulmonary disease (COPD). Although previous studies have supported 
      inhaled long-acting bronchodilators (ILABs) for overall cardiovascular safety, 
      the risk of specific cardiovascular outcomes such as arrhythmia, heart failure 
      and stroke is still unknown. Materials and methods: We systematically searched 
      from PubMed, the Embase database and the Cochrane Library for published studies 
      on ILABs and COPD, from its inception to November 10, 2018, with no language 
      restrictions. The RRs and corresponding 95% CIs were pooled to evaluate 
      ILAB/placebo. Results: Finally, 43 randomized controlled trials were included. 
      Compared with placebo, ILABs do not increase the risk of overall and specific 
      cardiovascular adverse events (AEs); on the contrary, they can reduce the 
      incidence of hypertension (RR 0.73, 95% CI 0.55-0.98;I(2)19.9%; P= 0.221). 
      However, when stratified according to the specific agents of ILABs, olodaterol 
      might reduce the risk of overall cardiovascular adverse events (OCAEs) (RR 0.65, 
      95% CI 0.49-0.88;I(2)27.5%; P= 0.000), and the protective effect of lowing blood 
      pressure disappeared. Similarly, the use of inhaled LABA might increase the risk 
      of cardiac failure (RR 1.71, 95% CI 1.04-2.84;I(2)0%; P= 0.538), but this risk 
      disappeared when stratified according to the specific agents of LABA. Besides, 
      formoterol might decrease the risk of cardiac ischemia (RR 0.53, 95% CI 
      0.32-0.91; I(2)0%; P= 0.676). Conclusions: Overall, the use of ILABs was not 
      associated with overall cardiovascular AEs in patients with stable COPD. When 
      stratified according to the specific agents of LABA, olodaterol might reduce the 
      risk of OCAE; and formoterol might decrease the risk of cardiac ischemia. LABA 
      might reduce the incidence of hypertension, but might increase the risk of heart 
      failure. Therefore, COPD patients with a history of heart failure should use it 
      with caution.
FAU - Li, Chenxi
AU  - Li C
AD  - Department of Respiratory, Affiliated Hospital of Qinghai University, Xining, 
      People's Republic of China.
FAU - Cheng, Wenke
AU  - Cheng W
AD  - Department of Cardiology, Affiliated Hospital of Qinghai University, Xining, 
      People's Republic of China.
FAU - Guo, Jin
AU  - Guo J
AD  - Department of Respiratory, Affiliated Hospital of Qinghai University, Xining, 
      People's Republic of China.
FAU - Guan, Wei
AU  - Guan W
AD  - Department of Respiratory, Affiliated Hospital of Qinghai University, Xining, 
      People's Republic of China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190411
PL  - New Zealand
TA  - Int J Chron Obstruct Pulmon Dis
JT  - International journal of chronic obstructive pulmonary disease
JID - 101273481
RN  - 0 (Adrenergic beta-2 Receptor Agonists)
RN  - 0 (Bronchodilator Agents)
RN  - 0 (Muscarinic Antagonists)
SB  - IM
MH  - Administration, Inhalation
MH  - Adrenergic beta-2 Receptor Agonists/*administration & dosage/adverse effects
MH  - Bronchodilator Agents/*administration & dosage/adverse effects
MH  - Cardiovascular Diseases/diagnosis/*epidemiology/physiopathology/prevention & 
      control
MH  - Cardiovascular System/*drug effects/physiopathology
MH  - Drug Administration Schedule
MH  - Heart Failure/epidemiology/physiopathology
MH  - Humans
MH  - Lung/*drug effects/physiopathology
MH  - Muscarinic Antagonists/*administration & dosage/adverse effects
MH  - Protective Factors
MH  - Pulmonary Disease, Chronic Obstructive/diagnosis/*drug 
      therapy/epidemiology/physiopathology
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6489598
OTO - NOTNLM
OT  - adverse events
OT  - bronchodilators
OT  - long-acting muscarinic antagonists
OT  - long-acting beta2-agonists
OT  - meta-analysis
COIS- The authors report no conflicts of interest in this work.
EDAT- 2019/05/23 06:00
MHDA- 2019/12/20 06:00
PMCR- 2019/04/11
CRDT- 2019/05/23 06:00
PHST- 2018/12/14 00:00 [received]
PHST- 2019/02/22 00:00 [accepted]
PHST- 2019/05/23 06:00 [entrez]
PHST- 2019/05/23 06:00 [pubmed]
PHST- 2019/12/20 06:00 [medline]
PHST- 2019/04/11 00:00 [pmc-release]
AID - 198288 [pii]
AID - 10.2147/COPD.S198288 [doi]
PST - epublish
SO  - Int J Chron Obstruct Pulmon Dis. 2019 Apr 11;14:799-808. doi: 
      10.2147/COPD.S198288. eCollection 2019.