Popular COPD treatment increases risk for cardiac events, cardiac death

September 23, 2008

New research out of Wake Forest University School of Medicine shows that use of the most commonly prescribed once-a-day treatment for chronic obstructive pulmonary disease (COPD) for longer than one month increases the risk of cardiovascular death, heart attack or stroke by more than 50 percent.

Researchers Sonal Singh, M.D., M.P.H., and Curt Furberg, M.D., Ph.D., of Wake Forest, along with Yoon K. Loke, at the University of East Anglia, UK, conducted a meta-analysis of 17 double-blind, randomized trials involving a total of 14,783 patients with COPD. Participants received treatment with inhaled anticholinergics, another form of active therapy or a placebo inhaler.

An analysis of the data showed that use of inhaled anticholinergics for more than one month significantly increased the risk of cardiovascular death, heart attacks, or strokes in COPD patients by 58 percent.

The results appear in the Sept. 24 issue of The Journal of the American Medical Association.

Inhaled anticholinergics are a class of drugs that relax the airways and prevent them from getting narrower, making it easier to breathe. They also protect the airways from spasms that can suddenly cause the airway to become narrower (bronchospasm).

The two most commonly used inhalers from the anticholinergic class are tiotropium bromide, marketed by Pfizer as Spiriva™, and ipratropium bromide, made and marketed by Boehringer Ingelheim as Atrovent™.

"Patients with COPD who use these inhalers are at a high risk of excess serious cardiovascular events due to their use," said Singh, an assistant professor of internal medicine. "In absolute terms, if these inhalers are used for one year, nearly one in 40 patients using these inhalers may develop cardiac death related to the drug, and nearly one in 174 patients may develop a heart attack associated with these inhalers."

COPD is the fourth-leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide. Cardiac death is leading cause of death among patients with COPD. Inhaled tiotropium is indicated for the long-term, once-daily maintenance treatment of symptoms associated with COPD and is the most widely used drug in COPD treatment. More than 8 million patients worldwide have used inhaled tiotropium since its approval.

The increased risk of cardiovascular events and cardiovascular death was particularly manifest in the five long-term trials (longer than 6 months) studied. In the 12 short-term trials, the direction of the drug effect was similar to that of the long-term trials.

"A regulatory reassessment of the cardiovascular safety concerns with this class of inhalers in patients with COPD is urgently needed," Singh said.

"These findings, especially the magnitude of the risk, and the consistency of the risk for heart attack, stroke and cardiac death, urge caution in the widespread use of these agents," he added. "Patients and doctors should decide whether these serious long-term cardiovascular risks outweigh their symptomatic benefits."

Source: Wake Forest University Baptist Medical Center

Explore further: Causes of death shifting in patients diagnosed with COPD

Related Stories

Causes of death shifting in patients diagnosed with COPD

January 20, 2011

Patients suffering from chronic obstructive pulmonary disease (COPD) who are on long-term oxygen therapy (LTOT) have more to worry about than breathing difficulties. According to a new study by researchers in Sweden, COPD ...

COPD patients often given wrong treatment

April 21, 2009

(PhysOrg.com) -- Generally speaking, patients with COPD (Chronic Obstructive Pulmonary Disease) deteriorate suddenly, in bursts, often as a result of bacterial or viral infections.

Common bronchodilator linked to increased deaths

September 15, 2008

A common bronchodilator drug which has been used for more than a decade by patients with chronic obstructive pulmonary disease (COPD) has been linked to a one-third higher risk of cardiovascular-related deaths.

New tool to predict the risk of death in COPD

August 28, 2009

Researchers have developed an index scale to help physicians predict a patient's risk of dying from chronic obstructive pulmonary disease (COPD). The ADO index can help physicians assess the severity of a patient's illness ...

Recommended for you

How the finch changes its tune

August 3, 2015

Like top musicians, songbirds train from a young age to weed out errors and trim variability from their songs, ultimately becoming consistent and reliable performers. But as with human musicians, even the best are not machines. ...

Machine Translates Thoughts into Speech in Real Time

December 21, 2009

(PhysOrg.com) -- By implanting an electrode into the brain of a person with locked-in syndrome, scientists have demonstrated how to wirelessly transmit neural signals to a speech synthesizer. The "thought-to-speech" process ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.