What is it about?
Compared with ICS/LABA, both dual LAMA/LABA and triple therapy increase the risk of major adverse cardiovascular events (MACE) and in particular non-fatal MIs and stroke in patients with COPD. However, the excess MACE risks should be balanced against their salutary effects. The benefits of dual LAMA/LABA or triple therapy include reduction in the frequency of exacerbations and hospitalizations, improvements in dyspnea, and health-related quality of life. Thus, one reasonable approach is for clinicians to determine the risk of MACE before initiating dual LAMA/LABA or triple therapy using widely used tools such as the Framingham global risk calculator, which has been validated for use in COPD patients and to avoid these medications (or use them very cautiously) in those whose average risk of MACE is >1% per year. In a word, the cardiovascular safety of these inhaled agents was in the descending order of ICS/LABA > ICS/LABA/LAMA > dual LABA/LAMA therapy.
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Why is it important?
Our results raise concerns about cardiovascular safety of dual LAMA/LABA and triple therapy.
Perspectives
Future RCTs should be designed to further evaluate the cardiovascular safety of LAMA/LABA therapy in different populations according to baseline cardiovascular risk.
Mingjin Yang
Read the Original
This page is a summary of: Combination therapy with long-acting bronchodilators and the risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis, European Respiratory Journal, September 2022, European Respiratory Society (ERS),
DOI: 10.1183/13993003.00302-2022.
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