Cardiovascular events in patients with COPD after long-acting bronchodilator initiation
Abstract
Background Real-world evidence concerning the cardiovascular (CV) risk of umeclidinium (UMEC) monotherapy or UMEC/vilanterol (VI) is scarce. This real-world study investigated CV risk in new users of UMEC or UMEC/VI versus new users of tiotropium (TIO) in patients with chronic obstructive pulmonary disease (COPD). Methods This prospective, observational, multinational, cohort study enrolled patients ≥18 years with COPD who initiated UMEC, UMEC/VI or TIO between 2 February 2016 and 31 January 2023. Noninferiority (95% confidence interval upper bound <2.0) of UMEC and UMEC/VI to TIO was compared for the time-to-first event (hazard ratio (HR) over 24 months) of a composite CV end-point of myocardial infarction, stroke, heart failure or sudden cardiac death. Stabilised inverse probability of treatment weighting adjusted for differences in baseline covariate balance between groups. Incidence rates for the composite CV end-point were calculated. Results In total, 6606 patients were enrolled; 6165 were included in the analysis. Both UMEC (n=1246) and UMEC/VI (n=2448) were noninferior to TIO (n=2471) for the risk of the composite CV end-point (adjusted HR (95% CI): UMEC versus TIO: 1.254 (0.830–1.896); UMEC/VI versus TIO: 1.352 (0.952–1.922)). Unadjusted composite CV incidence rates were low across cohorts (incidence rate (95% CI) per 100 person-years: UMEC: 1.157 (0.814–1.594); UMEC/VI: 1.287 (1.034–1.584); TIO: 0.924 (0.716–1.174)). Conclusions Both UMEC and UMEC/VI were…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 6,606 participants or records.
Read the paper
Related studies
- Characterization and Analysis of Porosity and Pore Structures
- Practical considerations for conducting ecotoxicity test methods with manufactured nanomaterials: what have we learnt so far?
- Dental Optical Coherence Tomography
- Radiation-shielding concrete: A review of materials, performance, and the impact of radiation on concrete properties
- Testing entanglement of annihilation photons
- Calanus finmarchicus seasonal cycle and diapause in relation to gene expression, physiology, and endogenous clocks
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.