Concurrent use of long-acting bronchodilators in COPD and the risk of adverse cardiovascular events

[摘要] The cardiovascular risk of concurrently using long-acting xcexb22-agonists (LABAs) and anticholinergics (LAMAs) in COPD is uncertain. We assessed the comparative cardiovascular and cerebrovascular safety of adding a second long-acting bronchodilator in patients with COPD.We identified a cohort of COPD patients; new users of LABA or the LAMA tiotropium during 2002xe2x80x932012; from the UK Clinical Practice Research Datalink. Using high-dimensional propensity scores; each patient adding a second bronchodilator was matched with a patient who remained on monotherapy. Patients were followed for 1xe2x80x85year for the occurrence of acute myocardial infarction (AMI); stroke; heart failure and arrhythmia.The cohorts included up to 31xe2x80x8a174 patients adding a bronchodilator matched to 31xe2x80x8a174 patients remaining on bronchodilator monotherapy. Adding a long-acting bronchodilator; compared to remaining on monotherapy; was not associated with an increased risk of AMI (hazard ratio (HR) 1.12; 95% CI 0.92xe2x80x931.36); stroke (HR 0.87; 95% CI 0.69xe2x80x931.10) or arrhythmia (HR 1.05; 95% CI 0.81xe2x80x931.36); but the risk was elevated for heart failure (HR 1.16; 95% CI 1.03xe2x80x931.30).Adding a second long-acting bronchodilator in the real-world-setting treatment of COPD does not increase the risk of most cardiovascular events. The modest increase for heart failure warrants further investigation.

[学科分类] 呼吸医学