Cardiovascular Events According to Inhaler Therapy and Comorbidities in Chronic Obstructive Pulmonary Disease

• Published in: International journal of chronic obstructive pulmonary disease 2024-01, Vol.19, p.243-254
• Main Authors: Kim, Eun Kyung, Lee, Eunyoung, Park, Ji Eun, Lee, Jae Seung, Choi, Hye Sook, Park, Bumhee, Sheen, Seung Soo, Park, Kwang Joo, Rhee, Chin Kook, Lee, Sang Yeub, Yoo, Kwang Ha, Park, Joo Hun
• Format: Article
• Language: English
• Subjects: Analysis; Arrhythmia; cardiovascular event; Care and treatment; comorbidities; Comorbidity; copd; Development and progression; Emergency medical services; Heart failure; inhaler therapy; Lung diseases; Medical research; Medicine, Experimental; Original Research; Patient compliance; Tiotropium
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S433583

COPD coexists with many concurrent comorbidities. Cardiovascular complications are deemed to be major causes of death in COPD. Although inhaler therapy is the main therapeutic intervention in COPD, cardiovascular events accompanying inhaler therapy require further investigation. Therefore, this study aimed to investigate new development of cardiovascular events according to each inhaler therapy and comorbidities. This study analyzed COPD patients (age ≥ 40 years, N = 199,772) from the Health Insurance Review and Assessment Service (HIRA) database in Korea. The development of cardiovascular events, from the index date to December 31, 2020, was investigated. The cohort was eventually divided into three arms: the LAMA/LABA group (N = 28,322), the ICS/LABA group (N = 11,812), and the triple group (LAMA/ICS/LABA therapy, N = 6174). Multivariable Cox analyses demonstrated that, compared to ICS/LABA therapy, triple therapy was independently associated with the development of ischemic heart disease (HR: 1.22, 95% CI: 1.04-1.43), heart failure (HR: 1.45, 95% CI: 1.14-1.84), arrhythmia (HR: 1.72, 95% CI: 1.41-2.09), and atrial fibrillation/flutter (HR: 2.31, 95% CI: 1.64-3.25), whereas the LAMA/LABA therapy did not show a significant association. Furthermore, emergency room visit during covariate assessment window was independently associated with the development of ischemic heart disease, heart failure, arrhythmia, and atrial fibrillation/flutter ( < 0.05). Our data suggest that cardiovascular risk should be considered in COPD patients receiving triple therapy, despite the confounding bias resulting from disparities in each group.