PMID- 31306366
OWN - NLM
STAT- MEDLINE
DCOM- 20200616
LR  - 20200616
IS  - 1533-4023 (Electronic)
IS  - 0160-2446 (Linking)
VI  - 74
IP  - 3
DP  - 2019 Sep
TI  - Correlation of Inhaled Long-Acting Bronchodilators With Adverse Cardiovascular 
      Outcomes in Patients With Stable COPD: A Bayesian Network Meta-Analysis of 
      Randomized Controlled Trials.
PG  - 255-265
LID - 10.1097/FJC.0000000000000705 [doi]
AB  - A majority of existing studies have focused on the efficacy of inhaled 
      long-acting bronchodilators (ILABs), such as long-acting muscarinic antagonists 
      (LAMAs) and long-acting beta2-agonists (LABAs), and LABAs combined with LAMAs in 
      treating chronic obstructive pulmonary disease (COPD). The current meta-analysis 
      aimed to investigate the correlation of ILABs with specific cardiovascular 
      adverse events (CAEs). Five electronic databases, including PubMed, Embase, 
      Cochrane Library, Scopus, and Web of Science were systematically retrieved. 
      Finally, 16 randomized controlled trials were enrolled into the current 
      meta-analysis. Typically, the efficacy of 3 major classes of drugs (LABAs, LAMAs, 
      and LABAs combined with LAMAs), and 7 specific drugs (including formoterol, 
      glycopyrrolate, indacaterol, olodaterol, Salmeterol, tiotropium, and vilanterol) 
      for 4 CAEs, including myocardial infarction, cardiac failure (CF), ischemic heart 
      disease (IHD), and stroke in stable COPD patients, was examined. All the pooled 
      results were analyzed through the odds ratios (ORs) with the corresponding 95% 
      confidence intervals (CIs). The direct meta-analysis results suggested that LABAs 
      could increase the risk of CF in patients with stable COPD compared with placebo 
      controls (OR 1.70, 95% CI, 1.00-2.90). In addition, network meta-analysis results 
      indicated that LAMAs combined with LABAs would result in an increased risk of CF 
      in patients with stable COPD (OR 2.31, 95% CI, 1.10-5.09). According to the ILABs 
      specific drug analysis, formoterol may potentially have protective effects on IHD 
      compared with placebo controls (OR 0.45, 95% CI, 0.18-1.00). In conclusion, among 
      these 3 kinds of ILABs, including LAMAs, LABAs, and LABAs/LAMAs, for stable COPD 
      patients, LAMAs and LABAs are associated with the least possibility to induce 
      myocardial infarction and stroke, respectively. However, the application of LABAs 
      will probably increase the risk of CF; they should be used with caution for 
      stable COPD patients with CF. In addition, in specific-drug analysis, the use of 
      formoterol can reduce the risk of treatment-related IHD. Nevertheless, more 
      studies on different drug doses are needed in the future to further validate this 
      conclusion.
FAU - Wu, Jinchun
AU  - Wu J
AD  - Department of Cardiology, Qinghai Provincial People's Hospital, Xining, China.
FAU - Ye, Yi
AU  - Ye Y
AD  - Qinghai University Graduate School, Xining, China.
FAU - Li, Chenxi
AU  - Li C
AD  - Department of Respiratory, Affiliated Hospital of Qinghai University, Xining, 
      China.
FAU - Zhou, Wenqin
AU  - Zhou W
AD  - Qinghai University Graduate School, Xining, China.
FAU - Chang, Rong
AU  - Chang R
AD  - Department of Cardiology, Qinghai Provincial People's Hospital, Xining, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - J Cardiovasc Pharmacol
JT  - Journal of cardiovascular pharmacology
JID - 7902492
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  - Aged
MH  - Bronchodilator Agents/administration & dosage/*adverse effects
MH  - Cardiovascular Diseases/*chemically 
      induced/diagnosis/epidemiology/physiopathology
MH  - Cardiovascular System/*drug effects/physiopathology
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Muscarinic Antagonists/administration & dosage/*adverse effects
MH  - Network Meta-Analysis
MH  - Pulmonary Disease, Chronic Obstructive/diagnosis/*drug 
      therapy/epidemiology/physiopathology
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2019/07/16 06:00
MHDA- 2020/06/17 06:00
CRDT- 2019/07/16 06:00
PHST- 2019/07/16 06:00 [pubmed]
PHST- 2020/06/17 06:00 [medline]
PHST- 2019/07/16 06:00 [entrez]
AID - 10.1097/FJC.0000000000000705 [doi]
PST - ppublish
SO  - J Cardiovasc Pharmacol. 2019 Sep;74(3):255-265. doi: 
      10.1097/FJC.0000000000000705.