Risk of myocardial ischaemia and beta-adrenoceptor agonists

Modern therapy for both cardiovascular disease and obstructive lung disease involves diametrically opposed manipulations of the beta-adrenoceptor, Bet a-agonists reduce airflow limitation and improve symptoms among patients wi th obstructive lung disease while beta-blockers reduce symptoms, recurrent myocardial ischaemia and all-cause mortality among patients with ischaemic heart disease. There is biological plausibility for beta-agonists leading t o adverse cardiovascular outcomes, and observational trials have raised con cern about the safety of beta-agonists among patients with cardiovascular d isease. Although there are many potential causal and noncausal explanations for these observational findings, the implications from these studies are the same. Physicians should be careful when prescribing beta-agonists for p atients at risk for ischaemic heart disease. Furthermore, careful considera tion should be given to distinguish symptoms caused by cardiovascular versu s respiratory aetiologies.