Cardiovascular Outcomes Among Patients with COPD Prescribed with LABA or LAMA: A Real-World Territory Wide Study.

Introduction: This study aims to compare cardiovascular outcomes among patients who received long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) and thereby better inform the choice of pharmacotherapy prescription for patients with chronic obstructive pulmonary disease (COPD).

Method: A real-world territory-wide retrospective cohort study using electronic data patient databases in Hong Kong was conducted. Patients with COPD without cardiovascular disease who were new users of LABA or LAMA from public hospitals in Hong Kong between 2010 and 2019 were identified and were followed up for 3 years after treatment initiation. Incidences of cardiovascular events were compared. Propensity score matching was employed to match important patient characteristics and clinical features.

Results: After the propensity score matching, 5020 patients were included: 2510 treated with LABA and 2510 with LAMA. At 3-year follow-up, 19.6% of patients experienced cardiovascular events. LAMA treatment was associated with a higher incidence of cardiovascular events compared to LABA (20.2% vs 19.0%, adjusted hazard ratio [aHR] 1.14, p = 0.04). This difference was primarily driven by increased risks of new-onset atrial fibrillation (7.93% vs 6.53%, aHR 1.30, p = 0.01). Incidence rates were similar between groups for ventricular tachycardia and fibrillation (0.52% vs 0.80%, p = 0.32), acute coronary syndrome (4.06% vs 3.82%, p = 0.33), ischemic stroke (2.39% vs 2.59%, p = 0.98), and heart failure hospitalization (10.8% vs 9.84%, p = 0.05).

Conclusion: Patients with COPD treated with LAMA might have higher incidence of atrial fibrillation when compared with LABA but not other cardiovascular events.