Cardiovascular Risk of the Use of Long-Acting Bronchodilators in Patients With Asthma: A Meta-Analysis of 22 Randomized Controlled Trials.

Abstract

Long-acting bronchodilators can improve the control of asthma when added to inhaled corticosteroids. However, the cardiovascular safety of these drugs in patients with asthma has not been comprehensively evaluated. Notably, growing evidence has indicated a positive association between asthma and cardiovascular disease. To evaluate the cardiovascular safety of adding long-acting bronchodilators in patients with asthma. After a comprehensive search in PubMed, Embase, Cochrane Library, and Web of Science, we included randomized controlled trials that assessed the cardiovascular safety of long-acting bronchodilators in patients with asthma. The primary outcome was a comparison of the incidence of total cardiovascular adverse events (AEs). Secondary outcomes included drug-related AEs, AEs leading to discontinuation, serious AEs, and fatal AEs. A total of 22 trials with 62,915 patients were included. The use of long-acting bronchodilators significantly increased the incidence of cardiovascular AEs leading to discontinuation (incidence rate ratio = 3.05; 95% CI, 1.07-8.48). The incidence of total cardiovascular AEs, drug-related AEs, serious AEs, and fatal AEs was higher in patients treated with long-acting bronchodilators, but the differences were not significant. The certainty of evidence was low for comparations of total cardiovascular AEs and fatal AEs. The certainty of evidence was very low for comparisons of drug-related AEs, AEs leading to discontinuation, and serious AEs. The incidence of cardiovascular AEs was low in patients with asthma. Only the risk of AEs leading to discontinuation was significantly increased compared with those not exposed to long-acting bronchodilators. More studies are required to confirm these findings considering the potential reporting bias.