Oral anticoagulants and other cardiovascular drugs have demonstrated efficacy in reducing mortality in individuals with chronic obstructive pulmonary disease (COPD) and right-sided heart failure, according to a study recently published in the European Journal of Internal Medicine. This study included 5991 Danish individuals with COPD and right-sided heart failure, 51% of whom were women with a mean age of 74±10 years. Comorbidity status was defined by the use of loop-diuretics and a pulmonary hypertension diagnosis. The population was classified at baseline according to beta-blocker and renin-angiotensin inhibitor usage. Using a national administrative database, individuals were followed from 1995 to 2015 for all-cause mortality. Multivariable Cox regression models were used to examine the association between claimed cardiovascular drug prescriptions and mortality.
Of the study population, 36% (n=2149) were classified as using renin-angiotensin system inhibitors, 35% (n=2099) as using a low dose of aspirin, 30% (n=1824) as using spironolactone, 24% (n=1440) as using beta-blockers, 23% (n=1376) as using calcium channel blockers, 22% (n=1340) as using oral anticoagulants, and 20% (n=1194) as using statins. Follow-up lasted for 2.2±2.8 years (0-19.6 years), during which 85% (n=5071) of the participants died (38 per 100 person-years [95% CI, 37-39]). Mortality was significantly associated with older age, liver disease, chronic kidney disease, diabetes, prior heart failure diagnosis or severe myocardial infarction, and being a man.
Compared with using no drugs, statins resulted in an adjusted hazard ratio of 0.85 (95% CI, 0.78-0.92), calcium channel blockers in a ratio of 0.86 (95% CI, 0.80-0.92), oral anticoagulants in a ratio of 0.87 (95% CI, 0.80-0.95), beta-blockers in a ratio of 0.90 (95% CI, 0.84-0.98), renin-angiotensin system inhibitors in a ratio of 0.92 (95% CI, 0.86-0.98), low-dose aspirin in a ratio of 0.99 (95% CI, 0.93-1.05), and spironolactone in a ratio of 1.17 (1.10-1.24). Similar results were achieved with inverse probability-weighted models and analyses matched for propensity score.
Limitations to this study included an observational design, potential confounding despite generally homogeneous comorbidity, and a lack of data on echocardiography, pulmonary function testing, body mass index, functional status, and long-term oxygen therapy.
The researchers concluded that “[s]everal cardiovascular drugs, especially oral anticoagulants, may improve mortality in patients with advanced COPD and right-sided heart failure. Randomized clinical trials are warranted to test our hypothesis.”
Andersson C, Hansen PW, Steffensen IE, et al. Mortality associated with cardiovascular drugs in patients with chronic obstructive pulmonary disease and right-sided heart failure — a danish nationwide registry-based study [published online March 1, 2019]. Eur J Intern Med. doi:10.1016/j.ejim.2019.02.014.