National Evidence-based Healthcare Collaborating Agency, Namsan Square (Kukdong B/D) 173 Toegye-Ro, Jung-Gu, Seoul, 04554, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
Sci Rep. 2017 Dec 20;7(1):17915. doi: 10.1038/s41598-017-17890-1.
We investigated the association between the use of inhaled bronchodilators and the risk of AMI. A nested case-control study using the nationwide insurance claims database was conducted. Overall, 11,054 AMI cases and 47,815 matched (up to 1:5) controls were identified from 1,036,119 subjects without acute major cardiovascular events in the past year. Long-acting and short-acting β-agonists (LABAs and SABAs) were associated with increase in the risk of AMI, although an inhaled corticosteroid combined with a long-acting β-agonist was not. Long-acting muscarinic antagonists (LAMAs) in a dry powder inhaler (DPI) were significantly associated with reduced risk of AMI, while LAMAs in a soft mist inhaler (SMI) didn't decrease the risk of it. In hypertensive or diabetic patients, LAMAs in a DPI were associated with reduced risk of AMI, but LABAs were associated with increased risk. Among the β-blocker users, the reduction of AMI risk by LAMAs was the most significant. In conclusions, inhaled β-agonists were associated with increase in the risk of AMI, while LABAs accompanied by ICSs were not associated with increase in the risk of AMI. LAMAs in a DPI use were associated with lower risk of AMI.
我们研究了吸入性支气管扩张剂的使用与 AMI 风险之间的关系。使用全国性保险索赔数据库进行了一项嵌套病例对照研究。在过去一年中，在没有急性重大心血管事件的 1036119 名受试者中，共确定了 11054 例 AMI 病例和 47815 例匹配（最多 1:5）对照。长效和短效β激动剂（LABA 和 SABA）与 AMI 风险增加相关，尽管吸入皮质类固醇联合长效β激动剂不相关。干粉吸入器（DPI）中的长效毒蕈碱拮抗剂（LAMA）与 AMI 风险降低显著相关，而软雾吸入器（SMI）中的 LAMA 则未降低 AMI 的风险。在高血压或糖尿病患者中，DPI 中的 LAMA 与 AMI 风险降低相关，但 LABA 与风险增加相关。在β受体阻滞剂使用者中，LAMA 降低 AMI 风险的效果最为显著。总之，吸入性β激动剂与 AMI 风险增加相关，而含有 ICS 的 LABA 则与 AMI 风险增加不相关。DPI 中使用 LAMA 与 AMI 风险降低相关。
