Elderly patients suffering from chronic obstructive pulmonary disease (COPD) who are treated with long-acting bronchodilators ß-agonists and anticholinergics are at an increased risk of cardiovascular events, according to new research published in the journal JAMA Internal Medicine.
Over a quarter of Americans above the age of 35 suffer from COPD, it is one of the leading causes of death in the country. In fact, according to a previous study published in The Lancet, one out of four individuals aged 35 and over is likely to develop COPD at some stage of their lives.
COPD is a chronic disease that makes it hard for the patient to breathe - there is a lot coughing. The disease generally gets worse with time.
As background information, the authors wrote that the use of long-acting ß-agonists (LABAs) and long-acting anticholinergics (LAAs) is somewhat controversial because of the cardiovascular health risks associated with their usage.
In an invited commentary, Prescott G. Woodruff, M.D., M.P.H., of the University of California, San Francisco, said:
"No pharmacotherapy has been shown to meaningfully alter the rate of progression of chronic obstructive pulmonary disease (COPD). However, inhaled long-acting bronchodilators are mainstays of treatment in moderate to severe COPD because they improve lung function, dyspnea [shortness of breath], rate of exacerbations and quality of life."
Researchers from the Institute for Clinical Evaluative Sciences, Ontario, Canada, led by Andrea Gershon, M.D., M.S., carried out a case control analysis of a retrospective cohort study that identified the risk of cardiovascular complications among patients taking inhaled long-acting medications.
They used health care databases from Ontario which included all patients over the age of 66 who were diagnosed with COPD between 2003 and 2009. 53,532 of the 191,005 eligible patients were hospitalized or reported a emergency department visit or for a cardiovascular complication.
Results of the study revealed that a higher risk of cardiovascular events was associated with newly prescribed long-acting inhaled bronchodilators ß-agonists and anticholinergics compared to nonuse of the medications.
The authors of the study concluded:
"Among older individuals with COPD, new use of long-acting ß-agonists and anticholinergics is associated with similar increased risks of cardiovascular events. Close monitoring of COPD patients requiring long-acting bronchodilators is needed regardless of drug class."
A similar finding wa published in the September 24, 2008 issue of the Journal of the American Medical Association, JAMA. Researchers published evidence on the widely prescribed anticholinergics ipratropium bromide and tiotropium bromide (marketed as Atrovent and Spiriva), and found they were associated with an increased risk of cardiovascular death, heart attack and stroke among COPD patients.
Written by Joseph Nordqvist