Conditional logistic regressions were performed to estimate odds ratios of CVD from LABA and LAMA treatment. Main Outcomes and Measures Cases with inpatient or emergency care visits for coronary artery disease, heart failure, ischemic stroke, or arrhythmia were identified and individually matched to 4 randomly selected controls. Objective To investigate risk of CVD associated with LABAs and LAMAs, focusing on the initiation and duration of LABA and LAMA therapies.ĭesign, Setting, and Participants This nested case-control study included 284 220 LABA-LAMA–naïve patients with COPD at least 40 years old (mean age, 71.4 years 68.9% men), retrieved from the Taiwan National Health Insurance Research Database for health care claims from 2007 to 2011.Įxposure LABA or LAMA use was measured in the year preceding the event or index date, stratified by duration since initiation of LABA or LAMA treatment, new and prevalent users, concomitant COPD medications, and individual agents. There is an urgent need to examine whether new use of and duration since initiating LABAs and LAMAs could act as important determinants of cardiovascular events. Pivotal and relevant randomized clinical trials included prior LABA or LAMA users and excluded patients with baseline CVD therefore, cardiovascular events arising from first-time LABA or LAMA use, if any, could not be observed. Importance The associations between cardiovascular disease (CVD) and inhaled long-acting β 2-agonists (LABAs) or long-acting antimuscarinic antagonists (LAMAs) in chronic obstructive pulmonary disease (COPD) are greatly debated. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Study flow diagram outlining the selection of study cohort The impact of unmeasured confounders assessed by the rule-out methodĮFigure 4. Specification of case and control periods in an alternative case-crossover studyĮFigure 3. CVD, cardiovascular disease COPD, chronic obstructive pulmonary disease ER, emergency department NHI represents National Health InsuranceĮFigure 2. Overview for the adopted nested case-control study design. Numbers needed to harm for patients who had an increased CVD risk from using LABAs and LAMAs in our primary and secondary analysesĮFigure 1. ![]() Clinical characteristics of CVD patients during the case and control periods in an alternative case-crossover studyĮTable 6. Case-crossover analysis for the risk of CVDs with use of LABA and LAMA within 30 daysĮTable 5. Risk of each primary cardiovascular outcome with new LABA and LAMA useĮTable 4. Comparison of CVD risk between new LAMA use and new LABA useĮTable 3. Diagnosis codes used to define the comorbidities and individual drugs of comedicationsĮTable 2. A case-crossover study for assessing the association between the CVD risk and use of LABAs and LAMAsĮTable 1. Modeling a nonlinear duration-response association using a restricted cubic splines function model.ĮMethods 3. ![]() Development of a disease risk score-matched nested case-control studyĮMethods 2.
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