Study Indicates ICS May Reduce New Cardiac Events in Patients With COPD

A recent study examined whether inhaled corticosteroids (ICS) might lower the risk of future coronary heart disease (CHD) in patients with chronic obstructive pulmonary disease (COPD).

Previous studies have indicated that ICS can reduce deaths from CHD, a common comorbidity in COPD, but results have been far from definitive because some patients were already on the most common COPD medications, making it difficult to understand the direct effects.

Respiratory therapies for COPD include long-acting muscarinic antagonists, long-acting beta-2 agonists (LABA), and ICS, with ICS generally combined with LABA in a single device.

Using population-based data from 2002 to 2013 from the Korean National Health Insurance Service’s National Sample Cohort (NHIS-NSC), researchers sought to assess the effect of ICS on CHD in patients with COPD.

They included patients who were newly diagnosed with COPD between 2004 and 2013, prescribed an inhaler, and who were not diagnosed with CHD before a COPD diagnosis. They excluded patients who had been diagnosed with COPD or were prescribed inhalers between the years 2002 and 2003 in order to create the effect of a washout period.

To avoid miscoding, the researchers required that patients were prescribed inhaler medicines at least twice per year. The main outcome was a diagnosis of CHD, as defined by 1 or more of the following: at least 1 hospitalization based on the CHD diagnosis code; at least 2 outpatient visits for CHD; or at least 1 revascularization.

Results were analyzed using multivariable Cox regression models using time-dependent methods.

Out of 4400 patients with COPD, 771 patients were diagnosed as CHD incident cases during a median follow-up of 1 year (interquartile range 0.1–2.9).

The cumulative dose of ICS was linked with a reduced risk of CHD (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.52–0.89). When the cumulative exposure dose of ICS was divided into quartiles, the use of ICS had the biggest impact in reducing CHD incidence for the entire population (aHR, 0.70; 95% CI, 0.55–0.88) in the highest quartile by ICS dose for the entire study population as well as for some subgroups, particularly adults over 55 years, men under 55 years, and former smokers.

How ICS may be protective against CHD in patients with COPD remains unknown, but the authors said it might have something to do with reducing acute exacerbations (AE) of COPD, as some prior studies have pointed to a link between AE-COPD and the risk of cardiovascular disease.

However, additional research is needed to "determine whether a certain amount of ICS exposure in COPD patients is protective against CHD," they concluded.

Reference

Shin J, Yoon H-Y, Lee YM, Ha E. Inhaled corticosteroids in COPD and the risk for coronary heart disease: a nationwide cohort study. Sci Rep. Published online November 4, 2020. doi: 0.1038/s41598-020-74854-8