People who take inhaled corticosteroids for their chronic obstructive pulmonary disease (COPD) may be at lower risk for developing certain cardiovascular diseases, a review study has found.
The study, “Inhaled Corticosteroids and Risk of Cardiovascular Disease in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Regression,” was published in the journal Chronic Obstructive Pulmonary Diseases.
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Cardiovascular diseases estimated to affect at least 14% of COPD patients
In people with COPD, symptoms such as shortness of breath and persistent cough tend to get gradually worse over time. Cardiovascular diseases (CVDs) are estimated to affect between 14% and more than 60% of COPD patients, and are a common cause of death in this patient population.
The two diseases are thought to share some underlying mechanisms such as inflammation and a type of cellular damage called oxidative stress, as well as risk factors that include smoking, age, and air pollution.
Inhaled corticosteroids are used in COPD to help ease airway inflammation and prevent flare-ups, or periods of sudden symptom worsening. Years of research, however, have produced mixed results about the link between inhaled corticosteroids and cardiovascular risk in people diagnosed with COPD.
To clarify this, researchers at Imperial College London in the U.K. searched the literature for studies published up until June 1, 2022, that looked at this potential link. Inhaled corticosteroids included budesonide, fluticasone, beclomethasone, and mometasone, while cardiovascular diseases included heart failure, heart attack, and stroke.
Heart failure occurs when the heart doesn’t pump blood as well as it should to supply oxygen and nutrients to the body, while a heart attack occurs when the heart’s blood supply is suddenly cut off. A stroke happens when a blood vessel in the brain either becomes blocked or bursts.
Data from 240,903 COPD patients were included in final analysis
A total of 15 studies, covering up to 240,903 people with COPD, were included in the final analysis. Nine studies included hospital records or healthcare insurance data from the U.S., Canada, the U.K., Scotland, and Taiwan. The remaining six studies included data from appropriately-controlled clinical trials.
When the researchers combined the data of all 13 studies reporting survival or CVD event rate, they found that inhaled corticosteroids significantly reduced the probability of a COPD patient developing cardiovascular disease by 13%.
The risk was even lower — by 23% — when looking at studies with a follow-up greater than three years versus those with a follow-up of three years or less. It was lower still, by 38%, based on data from studies that had excluded people with a history of cardiovascular disease versus those without this criterion.
In turn, studies comparing inhaled corticosteroids with bronchodilators (a type of medication that widens the airways to make breathing easier) reported a 54% increase in CVD risk versus studies where inhaled corticosteroids were compared with a placebo.
Inhaled corticosteroids linked to reduced cardiovascular disease risk for some
Pooled data showed that inhaled corticosteroids were linked to a significantly reduced CVD risk only in studies following patients for more than three years (by 25%), and those comparing inhaled corticosteroid use to placebo or short-acting bronchodilators (by 20%), but not long-acting bronchodilators.
Short-acting bronchodilators are used for quick relief during a flare-up, whereas long-acting bronchodilators are used to provide control on a daily basis.
Studies that did not exclude patients based on previous CVD also showed a 13% significantly reduced pooled CVD risk, while those including such patients found no such link.
“Our systematic review and meta-analysis found an association between ICS-containing [inhaled corticosteroid-containing] medication and decreased risk of CVD in people with COPD and results suggest that subgroups of COPD patients may benefit from ICS use more than others, such as those on long-term ICSs,” the researchers wrote.
“Further studies are needed to better understand this relationship and whether this association varies by COPD [clinical profile] and patient characteristics,” they added.