Suissa S, Hemmelgarn B, Blais L, Ernst P
McGill Pharmacoepidemiology Research Unit, Department of Medicine, Royal Victoria Hospital, Montréal, Québec, Canada.
Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 1):1598-602. doi: 10.1164/ajrccm.154.6.8970341.
Bronchodilators used in the treatment of airway disease have been shown to have a variety of cardiac effects that may contribute to the occurrence of life-threatening events such as cardiac arrhythmias and cardiac arrest. We investigated whether theophylline and beta-agonists were associated with cardiovascular mortality among a cohort of subjects prescribed antiasthma medications. We used a population-based cohort of 12,301 subjects aged 5 to 54 yr, formed from health-insurance data bases from Saskatchewan, Canada, and spanning the period 1978 to 1987. Within this cohort, we identified all 30 deaths from cardiovascular causes in which acute asthma did not appear to be a contributing factor. We identified all asthma and cardiovascular drugs dispensed to these subjects shortly before their deaths and compared this therapy to that dispensed to a random sample of 4,080 person-time controls. After adjustment for age and the prior use of cardiac drugs, the rate of cardiovascular death was greater in users of theophylline, with a rate ratio (RR) of 2.7 (95% Cl:1.2 to 6.1), and in users of beta-agonists taken orally or by nebulizer (RR = 2.4; 95% Cl:1.0 to 5.4), but not in users of beta-agonists administered by metered-dose inhaler (RR = 1.2; 95% Cl:0.5 to 2.7). The great majority of cardiovascular deaths occurred among subjects with clinical or pathologic evidence of potentially lethal conditions. These results suggest that the use of theophylline and of beta-agonists administered orally or by nebulization should be avoided in subjects with significant cardiac disease or at high risk for such disease, especially acute coronary insufficiency and congestive cardiomyopathy. On the other hand, the use of beta-agonists administered by metered-dose inhalers (MDIs) was not associated with an increased risk of cardiovascular death.
用于治疗气道疾病的支气管扩张剂已被证明具有多种心脏效应，这些效应可能导致危及生命的事件发生，如心律失常和心脏骤停。我们调查了在一组开具抗哮喘药物的受试者中，茶碱和β受体激动剂是否与心血管死亡率相关。我们使用了一个基于人群的队列，该队列由来自加拿大萨斯喀彻温省医疗保险数据库的12301名5至54岁的受试者组成，时间跨度为1978年至1987年。在这个队列中，我们确定了所有30例心血管原因导致的死亡，其中急性哮喘似乎不是一个促成因素。我们确定了这些受试者在死亡前不久所配发的所有哮喘和心血管药物，并将这种治疗方法与随机抽取 的4080人次对照样本所接受的治疗方法进行比较。在对年龄和先前使用心脏药物进行调整后，茶碱使用者的心血管死亡率更高，率比（RR）为2.7（95%可信区间：1.2至6.1），口服或通过雾化器使用β受体激动剂的使用者也是如此（RR = 2.4；95%可信区间：1.0至5.4），但通过定量吸入器使用β受体激动剂的使用者则不然（RR = 1.2；95%可信区间：0.5至2.7）。绝大多数心血管死亡发生在有潜在致命疾病的临床或病理证据的受试者中。这些结果表明，对于有严重心脏病或此类疾病高风险的受试者，尤其是急性冠状动脉供血不足和充血性心肌病患者，应避免使用茶碱以及口服或雾化使用β受体激动剂。另一方面，通过定量吸入器（MDIs）使用β受体激动剂与心血管死亡风险增加无关。
