Abstract
Inhaled corticosteroids (ICS) might lower the risk of coronary heart disease (CHD) in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the association of ICS with the development of CHD in COPD patients by using data from the Korean Nationwide study. Patients who were newly diagnosed with COPD between 2004 and 2013 and who were not diagnosed with coronary heart disease before their diagnosis of COPD were included. Exposure of ICS was incorporated into multivariable Cox regression models using time-dependent methods. To accurately estimate ICS-exposure accumulation, a washout period of 2 years from 2002 to 2003 was applied. Among a total of 4,400 newly diagnosed COPD patients, 771 patients were diagnosed as CHD incident cases during a median follow-up of one year (interquartile range 0.1–2.9). The cumulative dose of ICS was associated with a reduced risk of CHD (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.52–0.89). When the cumulative exposure dose of ICS was divided into quartiles, the aHR for CHD incidence was 0.70 (95% CI, 0.55–0.88) in the highest quartile ICS dose use. The effect of ICS on reducing CHD incidence was pronounced in adults over 55 years, men under 55 years, and former smokers. Our findings demonstrate the role of ICS for the prevention of CHD in COPD patients without a history of CHD. Further research is needed to determine whether a certain amount of ICS exposure in COPD patients is protective against CHD.
Highlights
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by persistent airflow limitation and chronic respiratory symptoms due to exposure to environmental factors such as smoking in genetically susceptible individuals[1]
In the reference case, which classified Inhaled corticosteroids (ICS) exposure as a time-dependent variable, the use of ICS was not associated with a lower risk of coronary heart disease (CHD) in both crude and adjusted models (Table 2)
Our study included subjects from the national insurance cohort to assess the association between the use of ICS and risk of CHD in chronic obstructive pulmonary disease (COPD) patients with inhalers
Summary
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by persistent airflow limitation and chronic respiratory symptoms due to exposure to environmental factors such as smoking in genetically susceptible individuals[1]. ICS is generally combined with LABA in a single device These combined inhalers are recommended as initial therapy for selected COPD patients with an asthmatic component, severe respiratory symptoms, or frequent AEs; such patients have been previously identified to reap high benefits from ICS t herapy[3,4,5]. Two observational studies reported that ICS reduced the risk of acute myocardial infarction in patients with asthma and COPD10,11, while a large-scale RCT, SUMMIT (Study to Understand Mortality and Morbidity in COPD), of 16,590 patients with moderate COPD at high risk for cardiovascular events failed to demonstrate the same effects of ICS on mortality or cardiovascular o utcomes[7,12]. In Korea, the National Health Insurance Service (NHIS) manages the National Sample Cohort including about a million representative subjects Using these data, it is possible to investigate disease incidence and related risk factors in a large-scale national population. In this study, our aim was to assess the effect of ICS on coronary heart disease (CHD) in COPD patients
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