Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.
BMJ Open Respir Res. 2021 Jan;8(1). doi: 10.1136/bmjresp-2020-000840.
Cardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case-control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.
We used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged 45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.
From the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).
In real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.
心血管合并症在慢性阻塞性肺疾病（COPD）患者中很常见，人们担心长效支气管扩张剂（长效抗毒蕈碱药物（LAMA）和长效β激动剂（LABA））可能会进一步增加急性冠脉事件的风险。关于治疗强化对真实环境中急性冠脉综合征（ACS）风险影响的信息有限。我们进行了一项全国性嵌套病例对照研究，以估计 LAMA 和 LABA 联合使用相对于 LAMA 单一使用的 ACS 风险。
我们使用常规收集的国家卫生和药物配药数据，建立了一个年龄在 45 岁以上的队列，这些患者在 2006 年 2 月 1 日至 2013 年 12 月 30 日期间开始接受 COPD 的长效支气管扩张剂治疗。使用医院出院和死亡率记录来确定随访期间的致命和非致命 ACS 事件。对于每个病例，我们使用风险集抽样随机选择最多 10 名对照者，通过出生日期、性别、队列入组日期（首次 LAMA 和/或 LABA 配药）和 COPD 严重程度进行匹配。
从队列中（n=83417），我们在 281292 人年的随访中发现了 5399 例 ACS 病例。与当前使用 LAMA 治疗相比，当前使用 LAMA 和 LABA 双重治疗与 ACS 的风险增加相关（OR 1.28（95%CI 1.13 至 1.44））。在仅限于致命病例的分析中，OR 为 1.46（95%CI 1.12 至 1.91）。
在真实的临床实践中，COPD 患者使用两种而非一种长效支气管扩张剂与 ACS 风险增加相关。
