Increased cardiac risks in COPD with new Rx inhalers

Older patients with chronic obstructive pulmonary disease (COPD) may be at increased risk for cardiovascular events with newly prescribed long-acting beta-agonists (LABAs) and long-acting anticholinergics (LAAs), and need to be followed closely by their healthcare providers, according to a study published online May 20 for JAMA Internal Medicine.

COPD became the third-leading cause of death in the United States in 2008. More than 6% of U.S. adults have been diagnosed with the disease. More than 12% of Americans who were between the ages of 65 and 74 years had a diagnosis of COPD in 2011, according to the Centers for Disease Control and Prevention.  Previous smokers are at increased risk of the disease.

The two first-line medications used to manage COPD are inhaled LABAs and LAAs; both have been associated with increased cardiovascular risks. Canadian researchers wanted to compare these classes of medications by assessing the risk of hospitalization and emergency department visits for cardiovascular events.

Andrea Gershon, MD, MS, of the Institute of Clinical Evaluative Sciences, Ontario, Canada, and her colleagues conducted a nested case-control analysis of a retrospective cohort study. They compared the risk of cardiovascular events between patients who received new prescriptions of inhaled LABAs and LAAs. Individuals included in the analysis were 66 years of age and older, had a diagnosis of COPD, and had been treated from September 2003 through March 2009.

During the six-year study, more than 53,000 of the 191,000 eligible patients, or 28%, had been hospitalized or been to the emergency department with a cardiovascular event. New use of LABAs and LAAs were associated with a higher risk of a cardiac event compared with those who did not use either of the two medications, Gershon reported.

“We found no significant differences in events between the two medications (adjusted odds ratio of long-acting inhaled beta-agonists compared with anticholinergics, 1.15 [95% CI, 0.95-1.38; P=.16]),” the researchers wrote.

COPD patients who receive long-acting bronchodilators should be monitored closely by healthcare providers, they concluded.