Am. J. Respir. Crit. Care Med., Volume 161, Number 3, March 2000, 827-830

The Risk of Myocardial Infarction Associated with Inhaled -Adrenoceptor Agonists

DAVID H. AU, ROZENN N. LEMAITRE, J. RANDALL CURTIS, NICHOLAS L. SMITH, and BRUCE M. PSATY

Division of Pulmonary and Critical Care Medicine, Department of Medicine; Cardiovascular Health Research Unit, Department of Medicine; and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, Health Services, University of Washington, Seattle, Washington

Beta-adrenoceptor agonists (-agonists), in widespread clinical use for obstructive lung disease, have been associated with an increased risk of cardiovascular mortality. The objective of this study was to assess the association between incident myocardial infarction and the use of inhaled -agonists. We performed a case-control study within the Group Health Cooperative of Puget Sound (GHC). Between 1989 and 1994, we identified 1,444 cases with an incident myocardial infarction and 4,094 control subjects frequency-matched on age, sex, hypertension, and index date. The computerized pharmacy database of the health maintenance organization (HMO) was used to assess the use of -agonists by metered dose inhaler (MDI). Cardiovascular risk factor information was obtained from medical record review. In comparison to subjects who did not fill a -agonist prescription, subjects who had filled one -agonist MDI prescription in the 3 mo prior to their index date had an elevated estimated risk of myocardial infarction (adjusted odds ratio [OR]: 1.67 [95% CI, 1.07 to 2.60]). The elevated risk was limited to those subjects who had a history of cardiovascular disease (adjusted OR: 3.22 [95% CI, 1.63 to 6.35]) and among those with cardiovascular disease, to new users of -agonists (adjusted OR: 7.32 [95% CI, 2.34 to 22.8]). There was no dose-response relationship between -agonists use and risk of myocardial infarction. In this study, new use of -agonists was associated with an increased risk of myocardial infarction, although we cannot determine if the association is causal. Our study suggests that clinicians should exercise caution when giving an initial -adrenoceptor agonist prescription to patients with cardiovascular disease. Au DH, Lemaitre RN, Curtis JR, Smith NL, Psaty BM. The risk of myocardial infarction associated with inhaled -adrenoceptor agonists.

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