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Bronchodilation and smoking interaction in COPD: A cohort pilot study to assess cardiovascular risk

van Dijk, Wouter D.; Lenders, Jacques W.M.; Holtman, Joran; Grootens, Joke; Akkermans, Reinier; Heijdra, Yvonne; Schermer, Tjard R.J.; van Weel, Chris

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Background: Smoking and bronchodilator treatment are both extensively studied as key elements in patients with chronic obstructive pulmonary disease. However, little is known about whether or not these elements interact in terms of developing cardiovascular diseases in patients with COPD. Objectives: To explore to what extent the risk of developing ischemic cardiovascular disease in COPD patients is mediated by smoking status, use of bronchodilators and - specifically - their interaction....[Show more]

dc.contributor.authorvan Dijk, Wouter D.
dc.contributor.authorLenders, Jacques W.M.
dc.contributor.authorHoltman, Joran
dc.contributor.authorGrootens, Joke
dc.contributor.authorAkkermans, Reinier
dc.contributor.authorHeijdra, Yvonne
dc.contributor.authorSchermer, Tjard R.J.
dc.contributor.authorvan Weel, Chris
dc.date.accessioned2015-12-13T22:49:19Z
dc.identifier.issn0025-7931
dc.identifier.urihttp://hdl.handle.net/1885/80484
dc.description.abstractBackground: Smoking and bronchodilator treatment are both extensively studied as key elements in patients with chronic obstructive pulmonary disease. However, little is known about whether or not these elements interact in terms of developing cardiovascular diseases in patients with COPD. Objectives: To explore to what extent the risk of developing ischemic cardiovascular disease in COPD patients is mediated by smoking status, use of bronchodilators and - specifically - their interaction. Methods: We performed an observational pilot study on a relatively healthy Dutch COPD cohort from a primary care diagnostic center database with full information on spirometry tests, smoking status, bronchodilator use and other prescribed medication. We defined first ischemic cardiovascular events as primary outcome, measured by first prescription of antiplatelet drugs and/or nitrates. Unadjusted analyses by Kaplan-Meier were followed by adjusted Cox' proportional hazards. Results: 845 COPD patients, totaling 2,169 observation years, were included in the analyses. We observed an increased risk for nonfatal ischemic cardiovascular events by smoking (adjusted HR = 3.58, p = 0.001) and a protective effect of bronchodilators (adjusted HR = 0.43, p = 0.01). Although the protective effect of bronchodilators appears to be substantially minimized in patients that persist in smoking, we could not statistically confirm a hazardous interaction between bronchodilators and smoking (HR 2.50, p = 0.21). Conclusion: Our study reveals bronchodilators may protect from ischemic cardiovascular events in a relatively 'healthy' COPD population. We did not confirm a hazardous interaction between bronchodilators and smoking, although we observed current smokers benefit substantially less from the protective effect of bronchodilators.
dc.publisherKarger AG
dc.sourceRespiration; international review of thoracic diseases
dc.subjectKeywords: acetylsalicylic acid; acetylsalicylic acid calcium; acetylsalicylic acid plus dipyridamole; antithrombocytic agent; bronchodilating agent; carbasalate calcium; clopidogrel; dipyridamole; fenoterol; glyceryl trinitrate; ipratropium bromide; isosorbide 5 ni Bronchodilator; COPD; Interaction; Ischemic cardiovascular disease; Smoking
dc.titleBronchodilation and smoking interaction in COPD: A cohort pilot study to assess cardiovascular risk
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume83
dc.date.issued2012
local.identifier.absfor111717 - Primary Health Care
local.identifier.ariespublicationf5625xPUB8750
local.type.statusPublished Version
local.contributor.affiliationvan Dijk, Wouter D., Radboud University Nijmegen Medical Centre
local.contributor.affiliationLenders, Jacques W.M., Radboud University Nijmegen Medical Centre
local.contributor.affiliationHoltman, Joran, Radboud University Nijmegen Medical Centre
local.contributor.affiliationGrootens, Joke, Radboud University Nijmegen Medical Centre
local.contributor.affiliationAkkermans, Reinier , Radboud University Nijmegen Medical Centre
local.contributor.affiliationHeijdra, Yvonne, Radboud University Nijmegen Medical Centre
local.contributor.affiliationVan Weel, Chris, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationSchermer, Tjard R.J., Radboud University Nijmegen Medical Centre
local.description.embargo2037-12-31
local.bibliographicCitation.issue2
local.bibliographicCitation.startpage125
local.bibliographicCitation.lastpage132
local.identifier.doi10.1159/000326921
dc.date.updated2016-02-24T09:43:50Z
local.identifier.scopusID2-s2.0-84856491571
CollectionsANU Research Publications

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