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A controversy has developed that involves the inhaled anticholinergic agents ipratropium (Atrovent) and tiotropium (Spiriva). In a 2008 meta-analysis of randomized trials in patients with chronic obstructive pulmonary disease, these drugs were associated with excess risks for cardiovascular death and myocardial infarction (JAMA 2008; 300:1439). However, this meta-analysis did not include the UPLIFT trial — the largest and longest-term trial of tiotropium to date — which was published in 2009 (JW Gen Med Oct 27 2009). In UPLIFT, tiotropium was associated with significantly fewer serious cardiovascular events than was placebo.
Now, in a new analysis funded by the maker of tiotropium, researchers have pooled patient-level data from all placebo-…