Yeh Jun-Jun, Lai Mei-Chu, Yang Yu-Cih, Hsu Chung-Y, Kao Chia-Hung
Department of Family Medicine, Chest Medicine, Geriatric Medicine and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
College of Medicine, China Medical University, Taichung, Taiwan.
Front Cardiovasc Med. 2022 Feb 17;9:797623. doi: 10.3389/fcvm.2022.797623. eCollection 2022.
We investigated the effects of medication on heart disease and ischemic stroke (HDS) risk in patients with predominant bronchiectasis-asthma combination (BCAS).
BCAS and non-BCAS cohorts ( = 588 and 1,118, respectively) were retrospectively enrolled. The cumulative incidence of HDS was analyzed using Cox proportional regression; propensity scores were estimated using non-parsimonious multivariable logistic regression. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HDS were calculated, adjusting for sex, age, comorbidities, and medication {long- and short-acting β2 agonists and muscarinic antagonists (LABAs/SABAs and LAMAs/SAMAs), steroids [inhaled corticosteroid steroids (ICSs), oral steroids (OSs)], antiarrhythmics, antidepressants (fluoxetine), benzodiazepines (alprazolam, fludiazepam), statins and antihypertensive drugs (diuretics, cardioselective beta blockers, calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEi), angiotensin II blockers)}.
Compared with the non-BCAS cohort, the BCAS cohort taking LABAs, SABAs, SAMAs, ICSs, OSs, antiarrhythmics, and alprazolam had an elevated HDS risk [aHRs (95% CIs): 2.36 (1.25-4.33), 2.65 (1.87-3.75), 2.66 (1.74-4.05), 2.53 (1.61-3.99), 1.76 (1.43-2.18), 9.88 (3.27-30.5), and 1.73 (1.15-2.58), respectively except fludiazepam 1.33 (0.73-2.40)]. The aHRs (95% CIs) for LABAs ≤ 30 days, DDDs <415, ICSs ≤ 30 days were 1.10 (0.38-3.15), 2.95 (0.22-38.8), 1.45 (0.76-2.77). The aHRs (95% CIs) for current and recent alprazolam were 1.78 (1.09-2.93) and 777.8 (1.34-451590.0); for current and past fludiazepam were 1.39 (0.75-2.59) and 1.29 (0.42-4.01) and for past alprazolam was 1.57 (0.55-4.46); respectively. The aHRs (95% CIs) for alprazolam >30 DDDs, fludiazepam >20 DDDs, ICSs ≦415 DDDs, and OSs DDDs ≦15 were 1.60 (0.78-3.29), 2.43 (0.90-6.55), 5.02 (1.76-14.3), and 2.28 (1.43-3.62), respectively.
The bronchodilators, steroids, and antiarrhythmics were associated with higher risk of HDS, even low dose use of steroids. However, the current use of LABAs/ICSs were not associated with HDS. Benzodiazepines were relatively safe, except for current or recent alprazolam use. Notably, taking confounders into account is crucial in observational studies.
我们研究了药物治疗对以支气管扩张 - 哮喘为主的组合（BCAS）患者心脏病和缺血性中风（HDS）风险的影响。
回顾性纳入BCAS队列和非BCAS队列（分别为588例和1118例）。使用Cox比例回归分析HDS的累积发病率；使用非简约多变量逻辑回归估计倾向得分。计算HDS的调整后风险比（aHRs）和95%置信区间（CIs），并对性别、年龄、合并症和药物进行调整{长效和短效β2激动剂及毒蕈碱拮抗剂（LABAs/SABAs和LAMAs/SAMAs）、类固醇[吸入性糖皮质激素（ICSs）、口服类固醇（OSs）]、抗心律失常药、抗抑郁药（氟西汀）、苯二氮䓬类药物（阿普唑仑、氟地西泮）、他汀类药物和抗高血压药物（利尿剂、心脏选择性β受体阻滞剂、钙通道阻滞剂（CCBs）和血管紧张素转换酶抑制剂（ACEi）、血管紧张素II受体阻滞剂）}。
与非BCAS队列相比，服用LABAs、SABAs、SAMAs、ICSs、OSs、抗心律失常药和阿普唑仑的BCAS队列HDS风险升高[aHRs（95% CIs）：分别为2.36（1.25 - 4.33）、2.65（1.87 - 3.75）、2.66（1.74 - 4.05）、2.53（1.61 - 3.99）、1.76（1.43 - 2.18）、9.88（3.27 - 30.5）和1.73（1.15 - 2.58），氟地西泮除外，为1.33（0.73 - 2.40）]。LABAs使用≤30天、用药频度（DDDs）<415、ICSs使用≤30天的aHRs（95% CIs）分别为1.10（0.38 - 3.15）、2.95（0.22 - 38.8）、1.45（0.76 - 2.77）。当前和近期使用阿普唑仑的aHRs（95% CIs）分别为1.78（1.09 - 2.93）和777.8（1.34 - 451590.0）；当前和过去使用氟地西泮的分别为1.39（0.75 - 2.59）和1.29（0.42 - 4.01），过去使用阿普唑仑的为1.57（0.55 - 4.46）；阿普唑仑>30 DDDs、氟地西泮>20 DDDs、ICSs≤415 DDDs和OSs DDDs≤15的aHRs（95% CIs）分别为1.60（0.78 - 3.29）、2.43（0.90 - 6.55）、5.02（1.76 - 14.3）和2.28（1.43 - 3.62）。
支气管扩张剂、类固醇和抗心律失常药与较高的HDS风险相关，即使是低剂量使用类固醇。然而，当前使用LABAs/ICSs与HDS无关。苯二氮䓬类药物相对安全，但当前或近期使用阿普唑仑除外。值得注意的是，在观察性研究中考虑混杂因素至关重要。
