Chronic obstructive pulmonary disease: add-on tiotropium poses cardiovascular risk

Takeaway

• In patients with chronic obstructive pulmonary disease (COPD), newly added tiotropium to inhaled long-acting β₂ agonists (LABAs) and inhaled corticosteroids (ICSs) combination therapy was associated with an increased risk for severe cardiovascular events.

Why this matters

• Conflicting evidence was available prior to the current study on the use of tiotropium and risk for cardiovascular events.
• The triple therapy of tiotropium/LABA/ICS is reserved for patients with severe COPD with ≤30% forced expiratory volume in 1 second of predicted value but is widely used in clinical practice.

Study design

• This was a nested case-control study.
• 65,966 patients (age, ≥40 years) with COPD were treated with LABAs and ICSs from 2007 through 2011.
• Funding: Ministry of Science and Technology and Ministry of National Defense-Medical Affairs Bureau, Taiwan.

Key results

• Mean follow-up period of 0.8 years.
• 3188 incident cardiovascular disease cases and 12,349 matched patients were analysed.
• Newly added tiotropium during current periods (≤30 days) was associated with 88% higher risk for severe cardiovascular events (aOR, 1.88; P<.001).
• Newly added tiotropium during recent periods (31-60 days) was associated with 71% higher risk for severe cardiovascular events (aOR, 1.71; P=.002).
• The prevalent use of tiotropium did not increase the risk for severe cardiovascular events (current use, P=.71; recent use, P=.13).

Limitations

• Observational study.