Is Cardiovascular Disease in COPD Patients Affected by Which Long-Acting Bronchodilator Is Used?

Guidelines recommend either long-acting β-agonists (LABAs) or long-acting antimuscarinic agents (LAMAs) for initial treatment in patients with chronic obstructive pulmonary disease (COPD) who require daily therapy (NEJM JW Gen Med Oct 1 2012 and Am J Respir Crit Care Med 2013; 187:347). Concern has been raised that adverse cardiovascular events could be associated with these drugs because, in theory, LAMAs could suppress parasympathetic control and LABAs could stimulate sympathetic tone.

In this U.K. observational study, researchers compared cardiovascular outcomes with these two medications in patients with COPD. About 26,000 patients who had just started taking tiotropium (Spiriva, a LAMA) in 2002 through 2012 were matched to 26,000 simila…