Abstract
The cardiovascular risk of concurrently using long-acting β2-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 2002–2012, 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 1 year for the occurrence of acute myocardial infarction (AMI), stroke, heart failure and arrhythmia.
The cohorts included up to 31 174 patients adding a bronchodilator matched to 31 174 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 0.92–1.36), stroke (HR 0.87, 95% CI 0.69–1.10) or arrhythmia (HR 1.05, 95% CI 0.81–1.36), but the risk was elevated for heart failure (HR 1.16, 95% CI 1.03–1.30).
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.
Abstract
Adding 2nd long-acting bronchodilator in COPD safe for cardiovascular events; heart failure risk slightly increased http://ow.ly/Yj3G309ReeN
Footnotes
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Support statement: This research was funded in part by grants from the Canadian Institutes of Health Research (CIHR), the Canadian Foundation for Innovation (CFI) and Boehringer Ingelheim. S. Suissa is the recipient of the James McGill Professorship award. The sponsors were not directly involved in the design and conduct of the study, interpretation of the data or preparation of the manuscript. Boehringer Ingelheim was invited to comment on the study protocol and the manuscript. Modifications resulting from comments were made independently by the authors on the basis of scientific and editorial merit. Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received November 14, 2016.
- Accepted January 9, 2017.
- Copyright ©ERS 2017