Effect of ICS/LAMA/LABA versus LAMA/LABA Therapy on Cardiovascular Benefits in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.

PURPOSE: Recent evidence suggests that inhaled formulations containing inhaled corticosteroids (ICS) provide greater cardiovascular benefits to patients with chronic obstructive pulmonary disease (COPD) compared to those without ICS. However, no study has yet compared the cardiovascular outcomes of these inhalers in COPD populations based on baseline cardiovascular risk stratification. This study aims to evaluate the association between ICS/LAMA/LABA versus LAMA/LABA therapy and major adverse cardiovascular events (MACEs) in COPD patients with different levels of baseline cardiovascular risk.

PATIENTS AND METHODS: This study was conducted using data from the Hospital Information System (HIS) of the First Affiliated Hospital of Chongqing Medical University. Patients receiving ICS/LAMA/LABA were classified as the observation group, and those receiving LAMA/LABA as the control group. The primary outcome was MACEs. The primary analysis used an inverse probability of treatment-weighted Cox proportional hazards model.

RESULTS: Over a mean follow-up of 20.5 months, a total of 102 (19.2%) MACEs were recorded. Specifically, 53 events occurred in the LAMA/LABA group (22%), and 49 events occurred in the ICS/LAMA/LABA group (17%) (adjusted hazard ratio [HR] 0.481; 95% confidence interval [CI], 0.302-0.766; P=0.002). Cardiovascular risk stratification using the Framingham Risk Score showed that patients at high cardiovascular risk, triple therapy was associated with a significantly lower risk of MACEs compared with LAMA/LABA therapy (adjusted HR 0.435; 95% CI, 0.266-0.711; P < 0.001). Similarly, among patients with a history of cardiovascular disease (CVD), triple therapy was also associated with a lower risk of MACEs compared with LAMA/LABA therapy (adjusted HR 0.478; 95% CI, 0.282-0.808; P=0.006).

CONCLUSION: Among COPD patients, ICS/LAMA/LABA was associated with a lower risk of MACEs than LAMA/LABA therapy, particularly among those with high baseline cardiovascular risk or established CVD. These results still need to be further verified in future prospective studies.