Inhaled corticosteroids protect COPD patients from coronary heart disease

Inhaled corticosteroids (ICS) may reduce the risk of coronary heart disease (CHD) in patients with chronic obstructive pulmonary disease (COPD), particularly in those older than 55 years and in former smokers, reports a recent study.

The study included 4,400 patients (mean age, 59.1±11.5 years; 56.1 percent male) with newly diagnosed COPD and who had no history of CHD. ICS exposure was determined according to prescriptions, and those who were taking ICS at least twice a year after COPD diagnosis fit this definition. The primary study outcome was incident CHD.

Over a median follow-up of 1 year, 771 patients were diagnosed with CHD, yielding an incidence rate of 17.5 percent. Kaplan-Meier curves found significant differences in the development of CHD according to cumulative ICS dose (p<0.001) and sex (p=0.005).

In particular, higher cumulative doses seemed to have stronger effects (adjusted hazard ratio [HR], 0.68, 95 percent confidence interval [CI], 0.52–0.89; p=0.004).

The same held true when dose was divided into quartiles. Relative to patients who were given <30,000 µg of fluticasone equivalents, those who were in the highest quartile of dose (>207,500 µg fluticasone equivalent) saw a 30-percent reduction in the likelihood of developing CHR (HR, 0.70, 95 percent CI, 0.55–0.88; p=0.002).

The interaction between higher ICS cumulative dose and lower CHD risk was significant for patients aged >55 years (p=0.004), men <55 years (p=0.011), and former smokers (p=0.026).

However, when ICS was taken as a time-dependent exposure variable, it showed no significant interaction with CHD risk in both crude and adjusted models.