Use of inhaled corticosteroids and the risk of non-fatal acute myocardial infarction.
BACKGROUND
Use of inhaled corticosteroids may reduce the risk of acute myocardial infarction (MI) through reductions in systemic inflammation and C-reactive protein.


OBJECTIVE
To examine the association between the use of inhaled corticosteroids and the risk of non-fatal acute MI.


METHODS
In the Dutch PHARMO record linkage system database, we conducted a case-control study (2476 MI cases), nested in a cohort of antihypertensive drug users. The use of inhaled corticosteroids 100 days before the index date was compared with never use. We adjusted the analyses for the severity of the underlying respiratory disease and general drug and disease history.


RESULTS
We found that the use of inhaled corticosteroids was not associated with a decreased risk of non-fatal MI in antihypertensive drug users after adjustment for the underlying respiratory disease severity, adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 0.97-1.57. A higher daily dose (adjusted OR 1.82, 95% CI 0.80-4.13) and longer duration of use (adjusted OR 1.28, 95% CI 0.90-1.81) were not associated with a decreased risk of non-fatal MI. An inhaled corticosteroid dispensing in the 30 days before the index date was not protective but resulted in a 1.7-fold increased risk of non-fatal MI.


CONCLUSIONS
Our results do not support the hypothesis that inhaled corticosteroids protect against the risk of non-fatal MI by a reduction of systemic inflammation.
de Vries
Frank
F
Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, Universiteit Utrecht, Utrecht, The Netherlands. f.devries@pharm.uu.nl
Pouwels
Sander
S
Bracke
Madelon
M
Lammers
Jan-Willem
JW
Leufkens
Hubert
H
Klungel
Olaf
O
van Staa
Tjeerd
T
D000208:Acute Disease; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012307:Risk Factors; D013995:Time
D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D002097:C-Reactive Protein