β-adrenoceptor agonists increase cardiovascular risk

Reactions 1015 - 21 Aug 2004 β-adrenoceptor agonists increase cardiovascular risk β 2 -adrenoceptor agonist therapy appears to be associated with an increased risk of adverse cardiovascular effects in patients with obstructive airway disease, according to researchers from the US. The researchers conducted a meta-analysis, pooling data from 33 randomised, placebo-controlled clinical trials that investigated the short- or long-term cardiovascular effects of β-adrenoceptor agonists in patients with asthma or chronic obstructive pulmonary disease. Trials that allowed for as-needed β 2 -adrenoceptor agonist use in both the placebo and treatment groups were not excluded. Thirteen single- dose studies (n = 232) had extractable data on HR or potassium concentrations; the results of the meta- analysis showed that a single dose of a β2 -adrenoceptor agonist increased HR by 9.12 beats/min (95% CI 5.32, 12.92), and reduced potassium level by 0.36 mmol/L (0.18, 0.54), compared with placebo. Twenty longer- term studies (n = 6623) met the inclusion criteria of reporting at least one adverse cardiovascular event; the results of the meta-analysis showed that the risk of adverse cardiovascular events was significantly increased with β 2 -adrenoceptor agonist use (relative risk [RR] 2.54; 95% CI 1.59, 4.05) compared with placebo. Most events were due to sinus tachycardia, with a RR of 3.06 (95% CI 1.7, 5.5) compared with placebo. There was a trend towards an increase in major cardiovascular events, such as congestive heart failure, myocardial infarction, heart arrest and sudden death, but this did not reach significance. The researchers suggest that "β 2 -agonists could precipitate arrhythmias, ischemia, and congestive heart failure through the activation of β-adrenergic stimulation". They conclude that, until long-term trials have been conducted in patients with obstructive airway disease and concomitant heart disease to compare the efficacy and safety of β-adrenoceptor agonists with other therapies, "the available evidence needs to be examined closely in an attempt to reassess whether β 2 -agonists should be administered to patients with obstructive airway disease, with or without underlying cardiovascular conditions". Salpeter SR, et al. Cardiovascular effects of beta-agonists in patients with asthma and COPD. Chest 125: 2309-2321, No. 6, Jun 2004 800982601 1 Reactions 21 Aug 2004 No. 1015 0114-9954/10/1015-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of β-adrenoceptor agonists increase cardiovascular risk

Reactions 1015 - 21 Aug 2004

β-adrenoceptor agonists increasecardiovascular risk

β2-adrenoceptor agonist therapy appears to beassociated with an increased risk of adversecardiovascular effects in patients with obstructive airwaydisease, according to researchers from the US.

The researchers conducted a meta-analysis, poolingdata from 33 randomised, placebo-controlled clinicaltrials that investigated the short- or long-termcardiovascular effects of β-adrenoceptor agonists inpatients with asthma or chronic obstructive pulmonarydisease. Trials that allowed for as-neededβ2-adrenoceptor agonist use in both the placebo andtreatment groups were not excluded. Thirteen single-dose studies (n = 232) had extractable data on HR orpotassium concentrations; the results of the meta-analysis showed that a single dose of a β2-adrenoceptoragonist increased HR by 9.12 beats/min (95% CI 5.32,12.92), and reduced potassium level by 0.36 mmol/L(0.18, 0.54), compared with placebo. Twenty longer-term studies (n = 6623) met the inclusion criteria ofreporting at least one adverse cardiovascular event; theresults of the meta-analysis showed that the risk ofadverse cardiovascular events was significantlyincreased with β2-adrenoceptor agonist use (relative risk[RR] 2.54; 95% CI 1.59, 4.05) compared with placebo.Most events were due to sinus tachycardia, with a RR of3.06 (95% CI 1.7, 5.5) compared with placebo. Therewas a trend towards an increase in major cardiovascularevents, such as congestive heart failure, myocardialinfarction, heart arrest and sudden death, but this didnot reach significance.

The researchers suggest that "β2-agonists couldprecipitate arrhythmias, ischemia, and congestive heartfailure through the activation of β-adrenergicstimulation". They conclude that, until long-term trialshave been conducted in patients with obstructive airwaydisease and concomitant heart disease to compare theefficacy and safety of β-adrenoceptor agonists withother therapies, "the available evidence needs to beexamined closely in an attempt to reassess whetherβ2-agonists should be administered to patients withobstructive airway disease, with or without underlyingcardiovascular conditions".Salpeter SR, et al. Cardiovascular effects of beta-agonists in patients with asthmaand COPD. Chest 125: 2309-2321, No. 6, Jun 2004 800982601