medwireNews: The risk for cardiovascular events among older patients with chronic obstructive pulmonary disease (COPD) is similar if they begin treatment with long-acting ß-agonists (LABAs) or muscarinic antagonists (LAMAs), show results from a large, population-based study.
However, these patients still had a significantly greater odds for cardiovascular hospitalization or emergency department visit than those who did not take either of the drugs.
"These results support the need for close monitoring of all patients with COPD who require long-acting bronchodilators regardless of drug class," say authors Andrea Gershon (University of Toronto, Ontario, Canada) and colleagues.
The study, published in JAMA, included 191,005 patients with COPD aged 66 years or older, who received a LABA or LAMA for the first time in at least a year between September 2003 and March 2009. Overall, 53,532 (28.0%) had a cardiovascular event within 90 days of their prescription.
In a control-matched analysis of 26,638 patients who had a cardiovascular event, LABA use and LAMA use were associated with a 31% and 14% greater odds for an event, respectively, independent of gender, preexisting cardiovascular disease, and COPD severity. However, there was no statistically significant difference in the odds between users of the two drug classes.
The authors note that new use of LAMA appeared to have a protective effect for ischemic stroke, while LABA did not, resulting in a 73% increased risk in new LABA users compared with new LAMA users. Otherwise, there were no significant differences between the two drug classes with regards to specific cardiovascular outcomes.
Writing in an accompanying editorial, Prescott Woodruff of the University of California, San Francisco, USA, says that the use of bronchodilators as the mainstay treatment for COPD has been clouded by uncertainty over their association with cardiovascular risks.
Woodruff notes that, although Gershon and colleagues say that close monitoring of patients is needed, no specific recommendation on what shape that monitoring should take can be made on the basis of current understanding.
"Monitoring, of course, is the responsibility of an informed treating physician," he comments. "The main contribution of this study is to highlight that responsibility."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013