ArticleBMC pulmonary medicine2019
Anticholinergics aggravate the imbalance of the autonomic nervous system in stable chronic obstructive pulmonary disease.
Article in BMC pulmonary medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- Anticholinergic drug burden and incident cardiovascular events: a population-based study.BMC medicine · 2026Article
- Cardiovascular Outcomes Among Patients with COPD Prescribed with LABA or LAMA: A Real-World Territory Wide Study.Advances in therapy · 2025Article
- Heart Rate Recovery After Cardiopulmonary Exercise Test Predicts Acute Exacerbations in Patients with Moderate Chronic Obstructive Pulmonary Disease.International journal of chronic obstructive pulmonary disease · 2025Article
- The application value of 24 h Holter monitoring indices in predicting MACEs outside the hospital within three years after PCI in patients with STEMI.Frontiers in cardiovascular medicine · 2024Article
- Autonomic modulation and the risk of dementia in a middle-aged cohort: A 17-year follow-up study.Biomedical journal · 2023Article
- Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study.BMJ (Clinical research ed.) · 2023Article
- A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.Journal of general internal medicine · 2021Article
- Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease.International journal of chronic obstructive pulmonary disease · 2020Article
- Atrial arrhythmias in chronic lung disease-associated pulmonary hypertension.Pulmonary circulationReview
- Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD.International journal of chronic obstructive pulmonary diseaseArticle
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundInhaled anticholinergics, recommended as first-line maintenance treatment for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), has been demonstrated to be associated with an increased risk of cardiovascular diseases. Nevertheless, why COPD patients using inhaled anticholinergics have this higher risk remains unknown. One of mechanisms may be an autonomic imbalance because anticholinergics yield reduced vagal nervous activity. To test our hypothesis, we studied heart rate recovery (HRR) after exercise, recognized as a marker of cardiac autonomic function, in COPD patients using and not using inhaled anticholinergics.
methodsSixty patients with COPD were involved in this study (mean FEV
resultsHRR was significantly lower in patients using tiotropium than in the controls (16 ± 6 vs 22 ± 8 beats/min, respectively, p < 0.05). Multivariate regression analysis revealed that tiotropium use and peak VCO
conclusionsThese findings suggest that anticholinergics bronchodilators reduce HRR after exercise in COPD patients. This has the potential to aggravate autonomic nervous imbalance. Therefore, we recommend that COPD patients taking anticholinergic bronchodilators should be considered for monitoring of cardiac function and prescribers should be alert for cardiovascular events that may arise from autonomic nervous imbalance.
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