RT Journal
A1 Oba Y
T1 RIsk of major adverse cardiovascular events with inhaled anticholinergics in patients with chronic obstructive pulmonary disease
JF JAMA
JO JAMA
YR 2009
FD March 25
VO 301
IS 12
SP 1223
OP 1226
DO 10.1001/jama.2008.947
UL http://dx.doi.org/10.1001/jama.2008.947
AB 
To the Editor: The meta-analysis of inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease (COPD) by Dr Singh and colleagues1 successfully collected unpublished data and combined it with published studies. However, a 4-year randomized controlled trial involving 5993 patients (Understanding Potential Long-term Impacts on Function With Tiotropium [UPLIFT])2 that was published shortly after this meta-analysis showed no evidence of an increased risk of cardiovascular adverse events with the use of tiotropium. One possible explanation that should be considered for this discordance is publication bias, as might be suggested by a funnel plot.