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Cardiovascular Events According to Inhaler Therapy and Comorbidities in Chronic Obstructive Pulmonary Disease
Eun Kyung Kim1, Eunyoung Lee2, Ji Eun Park3
1Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
International Journal of Chronic Obstructive Pulmonary Disease
|January 25, 2024
Summary
Triple therapy for COPD increases cardiovascular risks like heart failure and arrhythmia. LAMA/LABA therapy showed no significant association with these events, suggesting careful consideration of cardiovascular risk in patients on triple inhaler regimens.
Area of Science:
- Pulmonology
- Cardiology
- Pharmacotherapy
Background:
- Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with cardiovascular comorbidities.
- Cardiovascular complications are leading causes of mortality in COPD patients.
- Inhaler therapy, a cornerstone of COPD management, necessitates investigation into associated cardiovascular event risks.
Purpose of the Study:
- To investigate the development of new cardiovascular events in COPD patients based on different inhaler therapies.
- To analyze the association between specific inhaler combinations (LAMA/LABA, ICS/LABA, triple therapy) and cardiovascular outcomes.
- To assess the impact of comorbidities on cardiovascular event development in COPD patients undergoing inhaler treatment.
Main Methods:
- Analysis of a large cohort (N = 199,772) of COPD patients aged ≥ 40 years from the Korean Health Insurance Review and Assessment Service (HIRA) database.
- Categorization of patients into three treatment groups: LAMA/LABA (N = 28,322), ICS/LABA (N = 11,812), and triple therapy (LAMA/ICS/LABA) (N = 6174).
- Investigation of cardiovascular event development from the index date to December 31, 2020, using multivariable Cox analyses.
Main Results:
- Triple therapy (LAMA/ICS/LABA) was significantly associated with increased risks of ischemic heart disease (HR: 1.22), heart failure (HR: 1.45), arrhythmia (HR: 1.72), and atrial fibrillation/flutter (HR: 2.31) compared to ICS/LABA.
- LAMA/LABA therapy did not demonstrate a significant association with the development of these cardiovascular events.
- Emergency room visits were independently associated with higher risks of ischemic heart disease, heart failure, arrhythmia, and atrial fibrillation/flutter (p < 0.05).
Conclusions:
- COPD patients receiving triple inhaler therapy exhibit an elevated risk for developing cardiovascular events.
- Cardiovascular risk assessment is crucial for COPD patients, particularly those on triple therapy, considering potential confounding factors.
- The findings highlight the need to balance COPD symptom control with cardiovascular safety in treatment selection.
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