title: Increased risk of sudden cardiac arrest in obstructive pulmonary disease: a case-control study.
abstract: BACKGROUND
  We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use.
  
  
  METHODS
  A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs.
  
  
  RESULTS
  A higher risk of SCA was observed in patients with OPD (n = 190 cases [15%], 622 controls [11%]) than in those without OPD (OR adjusted for cardiovascular risk-profile 1.4 [1.2-1.6]). In OPD patients with a high cardiovascular risk-profile (OR 3.5 [2.7-4.4]) a higher risk of SCA was observed than in those with a low cardiovascular risk-profile (OR 1.3 [0.9-1.9]) The observed SCA risk was highest among OPD patients who received short-acting β2-adrenoreceptor agonists (SABA) or anticholinergics (AC) at the time of SCA (SABA OR: 3.9 [1.7-8.8], AC OR: 2.7 [1.5-4.8] compared to those without OPD).
  
  
  CONCLUSIONS
  OPD is associated with an increased observed risk of SCA. The most increased risk was observed in patients with a high cardiovascular risk-profile, and in those who received SABA and, possibly, those who received AC at the time of SCA.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Miriam Jacoba
authors.initials: MJ
authors.lastname: Warnier
authors.forename: Marieke Tabo
authors.initials: MT
authors.lastname: Blom
authors.forename: Abdennasser
authors.initials: A
authors.lastname: Bardai
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Berdowksi
authors.forename: Patrick Cyriel
authors.initials: PC
authors.lastname: Souverein
authors.forename: Arno Wilhelmus
authors.initials: AW
authors.lastname: Hoes
authors.forename: Frans Hendrik
authors.initials: FH
authors.lastname: Rutten
authors.forename: Anthonius
authors.initials: A
authors.lastname: de Boer
authors.forename: Rudolph Willem
authors.initials: RW
authors.lastname: Koster
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: De Bruin
authors.forename: Han Liong
authors.initials: HL
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors