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Inhaled long-acting bronchodilator use in COPD increases CVD risk

New use of long-acting beta 2-agonists and long-acting muscarinic antagonists in patients with COPD was associated with a 1.5-fold increased risk for cardiovascular disease within 30 days of initiation, according to data published in JAMA Internal Medicine.

“Long-acting beta 2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are the mainstay therapies for COPD; however, these agents were found to increase the risk of CVD, although the findings varied, concluding that there was no increased risk or that there was a 1.1- to 4.5-fold increased cardiovascular risk,” Meng-Ting Wang, PhD, from the School of Pharmacy at the National Defense Medical Center, Taiwan, and colleagues wrote.

Wang and colleagues conducted a nested case-control study to determine if the duration since initial use and new use of inhaled LABAs or LAMAs for COPD are determinants of CVD risk. They recruited 284,220 LABA-LAMA-naïve patients with COPD who were at least 40 years old (mean age, 71.4 years; 68.9% men) from the 2007 to 2011 Taiwan National Health Insurance Research Database for health care claims.

The researchers identified 37,719 patients with CVD (mean age, 75.6 years; 71.6% men) — defined as those who required inpatient or emergency care visits for coronary artery disease, heart failure, ischemic stroke or arrhythmia — then individually matched each to four randomly selected controls for a total of 146,139 matched controls (mean age, 75.2 years; 70.1% men). Follow-up occurred for a mean of 2 years.

Data showed that patients with COPD who initiated new LABA use had a 1.5-fold (95% CI, 1.35-1.67) increased cardiovascular risk within 30 days, and those who initiated new LAMA use had a 1.52-fold (95% CI, 1.28-1.8) increased risk. Prevalent use of LABA or LAMA reduced or eliminated the cardiovascular risk.

There was no difference in CVD risks between individual LABA agents, LAMA dosage forms and concomitant COPD regimens. An alternative case-crossover study revealed that the cardiovascular risk persisted regardless of CVD history or prior exacerbations.

“We caution physicians to closely monitor new users of LABAs or LAMAs for cardiovascular symptoms,” Wang and colleagues concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.