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Ipratropium Bromide for COPD May Up Cardiovascular Risks

But tiotropium associated with decreased risk of mortality, cardiovascular events in COPD

FRIDAY, Jan. 8 (HealthDay News) -- The use of the short-acting anticholinergic ipratropium bromide for chronic obstructive pulmonary disease (COPD) within the past six months increases the risk of a cardiovascular event (CVE), while the long-acting anticholinergic bronchodilator tiotropium reduces mortality and cardiovascular events among patients with COPD, according to two studies in the January Chest.

Sarika S. Ogale, Ph.D., of the University of Washington in Seattle, and colleagues enrolled 82,717 veterans with COPD who were followed until an initial hospitalization for a CVE, death, or the study end date. Exposure to an anticholinergic of four or fewer 30-day equivalents within the past six months was associated with a 40 percent increased risk of CVE, while exposure to more than four 30-day equivalents increased risk 23 percent. There was no increased CVE risk for subjects who took the anticholinergics more than six months prior.

Bartolome Celli, M.D., of Carita-St. Elizabeth's Medical Center in Boston, and colleagues conducted an analysis of data from 30 clinical trials of tiotropium in COPD patients. All-cause mortality was higher in the placebo group than in the tiotropium group. The cardiovascular end point also was higher in the placebo group, as was the incidence rate for cardiovascular mortality excluding nonfatal myocardial infarction and stroke.

"In clinical and practical terms, the (more expensive) tiotropium appears to be the drug of choice. Given the vast investment required, it is unlikely that we will ever see the needed prospective trial that further clearly defines the cardiovascular risk of short-acting anticholinergics," writes the author of an accompanying editorial.

The second study was paid for by Boehringer-Ingelheim, which co-markets Spiriva, and Pfizer. The editorial author reported financial ties to a number of pharmaceutical companies, including Boehringer.

Abstract - Ogale
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Abstract - Celli
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