Sept. 23, 2008 -- Two commonly used treatments for the lung disease known as
chronic obstructive pulmonary disease (COPD) boost the risk of heart attack, stroke, or death from cardiovascular causes, according
to a new analysis. But the drugs' marketers sharply disagree.
The medicines under scrutiny are called inhaled anticholinergics, which work
by relaxing the muscles around constricted airways and relieving symptoms such
as shortness of breath.
The use of two commonly prescribed anticholinergics, Spiriva and Atrovent,
for more than a month boosted the risk of heart attack, stroke, or dying of
cardiovascular problems by 58%, says Sonal Singh, MD, MPH, assistant professor
of internal medicine at Wake Forest University School of Medicine in
Winston-Salem, N.C., and lead author of the study, which appears in The
Journal of the American Medical Association.
Singh and colleagues pooled the results of 17 randomized trials that
included nearly 15,000 patients who took the anticholinergics or a control
treatment. "Every study points in the same direction," he tells WebMD.
Meanwhile, pharmaceutical industry spokespeople issued a statement strongly
disagreeing with the conclusions of the study, issuing their own new analysis
that they say confirms the safety of Spiriva.
Singh and his colleagues looked at the 17 trials to see if the medicines
increased the risk of heart attack, stroke, and death from cardiovascular
disease or death from other causes.
They found that the COPD medicines increased risk of death from
cardiovascular disease as well as the risk of stroke or heart attack when the
three outcomes were grouped together, but the drugs did not significantly
increase the risk of death from all causes.
While 1.2% of control patients had a heart attack, stroke, or died from
cardiovascular disease during the follow-up (which ranged from six weeks to
five years), 1.8% of those on the anticholinergics did. That accounts for the
When Singh looked at the individual outcomes, rather than as a group, the
increased risk for stroke didn't turn out to be significant, but the risk for
heart attack and death from cardiovascular disease remained so.
The latest research isn't the first to uncover the risk. Atrovent was linked
with a 34% increased risk of cardiovascular death by other researchers, who
published their findings in the Annals of Internal Medicine last
COPD Medicines: Industry's View
Both medications are safe, according to spokespeople from pharmaceutical
companies that market Spiriva and Atrovent.
"Extensive research provides strong support for the safety of these
medications and is contrary to the conclusion expressed in the recently
released articles by Dr. Lee and colleagues [the Annals of Internal
Medicine study] and Dr. Singh and colleagues," says Lara Crissey, a
spokeswoman for Boehringer Ingelheim, which markets Atrovent and jointly
markets Spiriva with Pfizer Inc.