{"id":36764,"date":"2013-05-20T16:00:07","date_gmt":"2013-05-20T20:00:07","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=36764"},"modified":"2013-05-20T16:05:42","modified_gmt":"2013-05-20T20:05:42","slug":"similar-cardiovascular-risk-observed-with-copd-drugs","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/05\/20\/similar-cardiovascular-risk-observed-with-copd-drugs\/","title":{"rendered":"Similar Cardiovascular Risk Observed with COPD Drugs"},"content":{"rendered":"<p>A large observational study has found no difference in the increased risk for cardiovascular disease between the two main classes of drugs used in the first-line treatment of chronic obstructive pulmonary disease (COPD). LABAs (long-acting inhaled beta-agonists) and LAMAs (long-acting muscarinic antagonists) have a variety of beneficial effects in COPD patients, but evidence has been building that these agents may produce a small but significant increase in cardiovascular risk.<\/p>\n<p>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1689974\">a new study published online in\u00a0<em>JAMA Internal Medicine<\/em><\/a>, Andrea Gershon and colleagues analyzed data from nearly 200,000 elderly COPD patients from Ontario, Canada. Of these, 28% of the group had a cardiovascular event. When compared to matched controls not taking either of the drugs, new users of the two drugs were more likely to experience a cardiovascular event \u00a0(odds ratio\u00a0for LABAs: 1.31, CI 1.12-1.52; OR for LAMAs: 1.14, CI 1.01-1.28). The difference between LABAs and LAMAs was not significant. The elevated risk for both class of drugs was highest in the first few weeks after the start of treatment.<\/p>\n<p>The results, write the authors, &#8220;support the need for close monitoring of all patients with COPD who require long-acting bronchodilators regardless of drug class.&#8221;<\/p>\n<p>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1689980\">an accompanying commentary<\/a>, Prescott Woodruff writes that the study provides an accurate portrait of the real-world use of these drugs. The study, he notes, &#8220;captures early &#8216;sentinel&#8217; events\u00a0that might otherwise lead to participant exclusion\u00a0in a clinical trial.&#8221; However, the study does not provide information about the relative safety of a newer formulation of one LAMA, the Respimat Soft Mist Inhaler (Boehringer Ingelheim), which delivers a smaller dose of tiotropium in a fine cloud but may result in higher plasma levels. The safety of the Respimat system is now being studied in a large trial. In addition, the Ontario study did not study any difference in effect that might exist between LAMAs and LAMAs when used in combination with inhaled corticosteroids.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A large observational study has found no difference in the increased risk for cardiovascular disease between the two main classes of drugs used in the first-line treatment of chronic obstructive pulmonary disease (COPD). LABAs (long-acting inhaled beta-agonists) and LAMAs (long-acting muscarinic antagonists) have a variety of beneficial effects in COPD patients, but evidence has been [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,14],"tags":[1826,1741,1824,1825],"class_list":["post-36764","post","type-post","status-publish","format-standard","hentry","category-general","category-heart-failure","tag-bronchodilators","tag-copd","tag-long-acting-beta-agonists","tag-long-acting-muscarinic-antagonists"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36764","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=36764"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36764\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=36764"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=36764"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=36764"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}