Potential cardiovascular benefits of therapies for COPD

In the present study, patients with cardiovascular risk factors or disease at baseline had two to three times the MACE rate as patients without these at baseline. In both subgroups of patients, roflumilast conveyed a reduction in cardiovascular events, although the change appeared to be more substantial in patients without baseline cardiovascular diseases.

Studies have shown that patients with severe and moderate COPD also have evidence of systemic inflammation, including elevated circulating levels of tumor necrosis factor, IL-6, and C-reactive protein, compared with healthy people. Additionally, Sin and Man showed that an important link exists between systemic inflammation in COPD and cardiac injury in association with varying levels of airflow obstruction. Unfortunately, proinflammatory markers were not obtained in all the studies used in the present pooled analysis of cardiovascular events. However, it is known that PDE-4 inhibition provides a wide range of antiinflammatory canadian pharmacy online actions in vitro and in vivo. The oral PDE-4 inhibitor roflumilast has been shown to reduce airway inflammation in COPD as assessed by sputum neutrophil and eosinophil counts, an antiinflammatory benefit that may be associated with the ability of the drug to reduce exacerbations of COPD. Hence, the reduction in MACEs seen with roflumilast compared with placebo in the present analysis may be partly related to reductions in vascular inflammation induced by PDE-4 inhibition.

Few data exist with regard to potential cardiovascular benefits of therapies for COPD. Extensive analyses of the effects of long-acting b-agonists and inhaled corticosteroids on cardiovascular events have shown no harm, and a trend toward a mortality benefit for the combination of salmeterol and fluticasone proprionate has been observed in the TORCH (Toward a Revolution in COPD Health) trial. The long-term effects of the inhaled long-acting anticholinergic agent tiotropium on cardiovascular events was first reported in the UPLIFT (Understanding Potential Long-Term Impacts on Function With Tiotropium) trial and later reviewed in a pooled analysis of shorter-term placebo-controlled trials of the agent.