title: Cardiac safety of tiotropium in patients with cardiac events: a retrospective analysis of the UPLIFT® trial.
abstract: BACKGROUND
  Tiotropium is an anticholinergic bronchodilator for symptom relief and reducing exacerbations with an established safety profile in patients with chronic obstructive pulmonary disease (COPD). Using data from the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) study, we re-evaluated the safety of tiotropium HandiHaler® in patients who experienced recent myocardial infarction (MI), heart failure or unstable rhythm disorder during the study.
  
  
  METHODS
  A post-hoc analysis of all-cause mortality and serious cardiac adverse events (cardiac SAEs), including cardiac deaths and death unknown, was conducted in patients who had experienced cardiac arrhythmia, MI or cardiac failure during UPLIFT® and who completed the study. Descriptive analyses were performed.
  
  
  RESULTS
  Most patients experiencing cardiac events, for which they would have been excluded at baseline, remained in the trial. Kaplan-Meier analyses revealed a trend to later occurrence of cardiac SAEs with tiotropium HandiHaler® versus placebo. Patients who experienced a cardiac event and continued in UPLIFT® were not found to be at subsequently increased risk of all-cause mortality or cardiac SAEs with tiotropium treatment. Evaluation of deaths by major adverse cardiac events composite endpoints also showed that patients treated with tiotropium were not at increased risk of mortality or cardiac SAEs compared with placebo.
  
  
  CONCLUSIONS
  Risk of cardiac events, mortality or SAEs was not increased by tiotropium in patients experiencing cardiac events for which they would have been excluded at study baseline. The findings support the cardiac safety of tiotropium HandiHaler® in patients with COPD.
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. dtashkin@mednet.ucla.edu.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Tashkin
authors.affiliation: Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany. inge.leimer@boehringer-ingelheim.com.
authors.forename: Inge
authors.initials: I
authors.lastname: Leimer
authors.affiliation: Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany. norbert.metzdorf@boehringer-ingelheim.com.
authors.forename: Norbert
authors.initials: N
authors.lastname: Metzdorf
authors.affiliation: Respiratory Division, University of Leuven, Leuven, Belgium. marc.decramer@uzleuven.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
mesh_terms: D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D000069447:Tiotropium Bromide / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D000069447:Tiotropium Bromide