November 21st, 2014
A bit of medical humor: Ask a cardiologist about the purpose of the body and s/he will tell you it’s to support the function of the heart. Ask a pulmonologist about the purpose of the body and s/he will tell it’s to support the function of the lungs. This reminds of the late Rodney King’s immortal quote, “Can we all get along?”. I mention this because it often comes down to the primary care provider, a family physician or general internist, to help a patient torn between two opposing therapeutic regimens. For instance, beta blockers are often used in those with heart disease but their antithesis, beta agonists, are used in common lung diseases. But patients often have both conditions, which then begs the question, “Which medication should I use, doc?”
In a nested case-control analysis of a retrospective cohort study published early online last week in JAMA Internal Medicine, the authors noted that new use of long-acting beta agonists (LABA’s) and anticholinergics in older patients with chronic obstructive pulmonary disease (COPD), a common lung disease, was associated with an increase in cardiovascular events. The authors arrived at their conclusion by finding 191,005 patients with COPD and compared those who’d recently been prescribed a LABA and/or LAA to controls who were not prescribed either medication. The former were more likely to be hospitalized for a cardiovascular event soon after starting their LABA +/- LAA. Do note, all were older than 65.
So, what does this mean for you and me? First, we can’t live without our heart. Second, we can’t live without our lungs. Duh, right? But the fact remains that taking medications considered standard of care for COPD has just been linked to an increase in heart disease events. Granted this study doesn’t prove cause and effect. However, it does raise some grave concerns. At the very least, we need to monitor our patients more closely. And until more evidence is published, we’ll need to include cardiovascular events in our discussion regarding new use of LABAs and LAAs.
Gershon, A. (2013). Cardiovascular Safety of Inhaled Long-Acting Bronchodilators in Individuals With Chronic Obstructive Pulmonary DiseaseLong-Acting Bronchodilators in COPD JAMA Internal Medicine DOI: 10.1001/jamainternmed.2013.1016
long acting beta agonist copd, copd cardiovascular