![]() ![]() ICSs or ICSs combined with LABA was not associated with increase in AMI risk. We used four statistical models to evaluate the association between inhaled drugs and AMI. However, the majority of covariates, including other chronic respiratory diseases, comorbid dyslipidemia and the concomitant use of ACEI/ARB, statin, thiazide and calcium channel blocker, were well balanced between the cases with AMI and the controls because of extensive matching (Table 1). There were statistically significant differences because of the large sample size. We investigated whether the use of inhaled bronchodilators affects the risk of AMI by using the nationwide database in South Korea. These studies often lack external validation 16, 17, 18 and statistical power. ![]() Although several randomized controlled trials (RCTs) yielded important information concerning drug safety, there are a limited number of RCTs with which to verify the differences in the development of adverse events. In addition, there are also debates regarding the impact that the drug-delivery device has on the patient outcome 13, 15. However, there are debates about the link between the use of inhaled bronchodilators, including inhaled β2–agonists 4, 5, 6, 7, 8, 9 and anti-cholinergics 10, 11, 12, 13, 14, and the development of AMI. Of the possible cardiovascular adverse events, acute myocardial infarction (AMI) has been regarded as one of the most important issues concerning drug safety. Although inhaled therapy has advantages, such as rapid onset and fewer side effects compared with systemic administration, there have been concerns about the possibility of systemic adverse effects, including cardiovascular adverse events, because the drugs could be absorbed systemically after inhalation 3. The efficacy of inhaled bronchodilator therapy has been proven in patients with airway diseases such as chronic obstructive pulmonary disease (COPD) and asthma 1, 2. LAMAs in a DPI use were associated with lower risk of AMI. In conclusions, inhaled β-agonists were associated with increase in the risk of AMI, while LABAs accompanied by ICSs were not associated with increase in the risk of AMI. Among the β-blocker users, the reduction of AMI risk by LAMAs was the most significant. ![]() In hypertensive or diabetic patients, LAMAs in a DPI were associated with reduced risk of AMI, but LABAs were associated with increased risk. Long-acting muscarinic antagonists (LAMAs) in a dry powder inhaler (DPI) were significantly associated with reduced risk of AMI, while LAMAs in a soft mist inhaler (SMI) didn’t decrease the risk of it. Long-acting and short-acting β-agonists (LABAs and SABAs) were associated with increase in the risk of AMI, although an inhaled corticosteroid combined with a long-acting β-agonist was not. Overall, 11,054 AMI cases and 47,815 matched (up to 1:5) controls were identified from 1,036,119 subjects without acute major cardiovascular events in the past year. A nested case-control study using the nationwide insurance claims database was conducted. We investigated the association between the use of inhaled bronchodilators and the risk of AMI. ![]()
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