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March 25, 2009

Risk of Major Adverse Cardiovascular Events With Inhaled Anticholinergics in Patients With Chronic Obstructive Pulmonary Disease

JAMA. 2009;301(12):1223-1226. doi:10.1001/jama.2008.950

To the Editor: In the meta-analysis by Dr Singh and colleagues,1 the question was raised regarding biological causality for the increased cardiovascular mortality associated with the long-term use of tiotropium. According to the manufacturer's package insert,2 the number of participants with changes from the baseline-corrected QT interval of 30 to 60 msec was higher in the tiotropium group compared with the placebo group in a multicenter, randomized, double-blind trial of 198 patients with COPD. A lack of QTc effects with tiotropium was reported in the publication of that clinical trial; however, in that trial patients with renal impairment were excluded.3

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