S Singh

Dr S Singh, Wake Forest University School of Medicine, Winston-Salem, NC, USA; sosingh@wfubmc.edu

QUESTION

In patients with chronic obstructive pulmonary disease (COPD), do inhaled anticholinergics increase risk of major cardiovascular events?

REVIEW SCOPE

Included studies compared an inhaled anticholinergic with placebo or active drugs in patients with COPD and reported serious cardiovascular adverse events. Outcomes were a composite cardiovascular end point (non-fatal myocardial infarction, non-fatal stroke [including transient ischaemic attack], or cardiovascular death [including sudden death]), its components, and all-cause death.

REVIEW METHODS

Medline (Mar 2008), Cochrane Database of Systematic Reviews, websites of the US Food and Drug Administration and European regulatory authorities, clinicaltrials.gov, drug company product information sheets and clinical trials registers, reference lists, and Web of Science Citation Index were searched for English-language, published or unpublished, randomised controlled trials (RCTs) with >30 days of follow-up. 17 RCTs (n = 14 783, mean age 49–68 y, 58–99% men) met the selection criteria. The anticholinergic was tiotropium in 12 RCTs and ipratropium in 5 RCTs. The comparator was placebo in 9 RCTs, salmeterol in 5 RCTs, salmeterol plus fluticasone in 2 RCTs, …