COPD Meds Linked to 1.5-Fold Increase in CVD Risk

New initiation of inhaled long-acting β₂-agonists (LABAs) or long-acting antimuscarinic antagonists (LAMAs) in patients with chronic obstructive pulmonary disease (COPD) carries a 1.5-fold increase in severe cardiovascular (CV) risk, regardless of prior cardiovascular disease (CVD) and exacerbation history, according to a recent study.

For their study, the researchers evaluated 284,220 LABA-LAMA-naïve patients with COPD aged 40 years or older (mean age: 71.4 years). Mean follow-up lasted 2 years. Patient data were obtained from the Taiwan National Health Insurance Research Database for health care claims from 2007 to 2011.
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Additionally, at follow-up, the researchers identified and assessed 37,719 patients with emergency care visits for CVD (mean age: 75.6 years) as well as 146,139 matched controls (mean age: 75.2 years).

LABA or LAMA use was measured in the year prior to the event or index date. Patients were classified based on time since initiating LABA or LAMA treatment, new and prevalent use, concomitant COPD medications, and individual agents. Odds ratios of CVD from LABA and LAMA treatment were estimated via conditional logistic regressions.

Findings revealed that new initiation of LABA COPD was tied to a 1.50-fold higher CV risk within 30 days of initiation, while LAMA was associated with a 1.52-higher risk. However, this risk was absent or even reduced with prevalent use.

The researchers did not observe any differences in CVD risk with the use of individual LABA agents, LAMA dosage forms, and concomitant COPD regimens. However, in an alternate case-crossover study, they found that this risk persisted and remained across subgroups even in patients without history of CVD or prior exacerbations.

“New initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations,” the researchers concluded.

—Christina Vogt

Reference:

Wang MT, Liou JT, Lin CW. Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: a nested case-control study [Published online January 2, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.7720.