The cardiovascular effects of long-acting bronchodilators inhalers and inhaled corticosteroids purchases among asthma and COPD patients

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-01-03 DOI:10.1016/j.hrtlng.2024.12.010

Niv Lev-Ari , Bernice Oberman , Shiri Kushnir , Noga Yosef , Dekel Shlomi

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引用次数: 0

Abstract

Background

Confounding reports of cardiovascular disease (CVD) with the use of Inhaled corticosteroids (ICS), long-acting beta-agonists, and muscarinic antagonists (LABA and LAMA) have been reported.

Objective

To explore the relationship between the purchase of ICS, LABA and LAMA inhalers and the incidence of CVDs.

Methods

This retrospective study included patients with COPD and/or asthma, aged ≥ 18 years, who purchased LABA, LAMA, and ICS inhalers alone or in combination between 2017 and 2019. We calculated the odds ratios (ORs) for CVD for patients who purchased at least one inhaler during the 12 months before the diagnosis and those without any purchase from the same inhaler group. We also analyzed the risk among asthma patients and COPD patients.

Results

Of the 94,834-study population, 74,974 had asthma, 46,907 had COPD, and 27,047 had an asthma-COPD overlap. Average age was 57.9±19.7, and 44% were males. The most prominent effects of ICS were reduced risks for myocarditis (OR 0.35, 95%CI 0.14, 0.9), ischemic heart disease (IHD) (OR 0.45, 95%CI 0.41, 0.49), valvular disease (OR 0.47, 95%CI 0.39, 0.55) and hypertension (HTN) (OR 0.47, 95%CI 0.42, 0.52). LABA inhalers had a significantly lower risk for conduction disorders and arrhythmias (OR 0.71, 95%CI 0.55, 0.92), HTN (OR 0.76, 95%CI 0.63, 0.92), and cerebrovascular diseases (OR 0.83, 95%CI 0.74, 0.94). In comparison, patients with COPD had a significantly lower risk for heart failure (OR 0.62, 95%CI 0.48, 0.8). LAMA inhalers conferred a substantially lower risk of HTN (OR 0.66, 95%CI 0.57, 0.76), peripheral vascular diseases (OR 0.75, 95%CI 0.61, 0.92), IHD (OR 0.8, 95%CI 0.72, 0.89), and cerebrovascular disease (OR 0.85, 95%CI 0.78, 0.92).

Conclusion

ICS inhalers were associated with a significant reduction in the incidence of CVD, with lesser but significant effects observed among those using LABA and LAMA inhalers.

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哮喘和慢性阻塞性肺病患者购买长效支气管扩张剂、吸入剂和吸入皮质类固醇对心血管的影响。

背景：有报道称，心血管疾病（CVD）与吸入皮质类固醇（ICS）、长效β受体激动剂和毒蕈碱拮抗剂（LABA和LAMA）的使用存在混淆。目的：探讨ICS、LABA和LAMA吸入器的购买与心血管疾病发病率的关系。方法：本回顾性研究纳入了2017年至2019年期间单独或联合购买LABA、LAMA和ICS吸入器的年龄≥18岁的COPD和/或哮喘患者。我们计算了在诊断前12个月内购买至少一个吸入器的患者和未购买同一吸入器组的CVD患者的比值比（ORs）。我们还分析了哮喘患者和COPD患者的风险。结果：在94,834个研究人群中，74,974人患有哮喘，46,907人患有COPD， 27,047人患有哮喘-COPD重叠。平均年龄57.9±19.7岁，男性占44%。ICS最显著的效果是降低了心肌炎（OR 0.35, 95%CI 0.14, 0.9）、缺血性心脏病（OR 0.45, 95%CI 0.41, 0.49）、瓣膜病（OR 0.47, 95%CI 0.39, 0.55）和高血压（OR 0.47, 95%CI 0.42, 0.52）的风险。LABA吸入器发生传导障碍和心律失常（OR 0.71, 95%CI 0.55, 0.92）、HTN （OR 0.76, 95%CI 0.63, 0.92）和脑血管疾病（OR 0.83, 95%CI 0.74, 0.94）的风险显著降低。相比之下，COPD患者发生心力衰竭的风险显著降低（OR 0.62, 95%CI 0.48, 0.8）。LAMA吸入器显著降低了HTN （OR 0.66, 95%CI 0.57, 0.76）、外周血管疾病（OR 0.75, 95%CI 0.61, 0.92）、IHD （OR 0.8, 95%CI 0.72, 0.89）和脑血管疾病（OR 0.85, 95%CI 0.78, 0.92）的风险。结论：ICS吸入器与CVD发生率的显著降低相关，在使用LABA和LAMA吸入器的患者中观察到较小但显著的效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.