Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: A nested case-control study.

Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, Lai JH. JAMA Intern Med. 2018 Jan 2. [Epub ahead of print] [CrossRef] [PubMed] 

An article from Taiwan reports that new use of long-acting bronchodilators is associated with an early increase in the risk for cardiovascular disease (CVD). Cases with inpatient or emergency care visits for coronary artery disease, heart failure, ischemic stroke, or arrhythmia were identified and individually matched to 4 randomly selected controls. New long-acting beta agonist (LABA) and long-acting muscarinic antagonist (LAMA) use in COPD was associated with a 1.50-fold (95% CI, 1.35-1.67; P < .001) increased cardiovascular risk within 30 days of initiation. The risk was absent, or even reduced with prevalent use. Individual LABA agents, LAMA dosage forms, and concomitant COPD regimens did not differ in the CVD risks. The findings suggest that clinicians should "be very vigilant with regard to any cardiovascular symptoms within 30 days of initiating LABA or LAMA treatment for COPD”. After those initial 30 days, however, the risk for CVD associated with the use of long-acting bronchodilators appears to wane.