Risk of cardiovascular events and all-cause mortality in COPD: a real-world multicenter cohort study

Randomized controlled trials have shown a mortality benefit of inhaled triple therapy in patients with chronic obstructive pulmonary disease (COPD) and a high risk of exacerbations. However, real-world data remain controversial. This retrospective cohort study was conducted using data from the Chang Gung Research Database (CGRD). Patients aged ≥ 40 years diagnosed with COPD between January 2011 and December 2021 were included. The patients were divided into two groups according to their initial COPD treatment: (a) dual bronchodilators (LAMA/LABA) and (b) triple therapy (ICS/LAMA/LABA). The aim of this study was to evaluate outcomes including all-cause mortality, major adverse cardiovascular events (MACE), and exacerbations in patients with COPD. Among 24,165 patients with COPD, 15,267 (63.2%) received initial dual bronchodilators, and 8,898 (36.8%) received initial triple therapy. The majority of patients (79.3%) were men. The mean age at the index date was 69.3 ± 11.2 and 70.2 ± 11.4 years in the dual bronchodilator and triple therapy groups, respectively. Patients on initial triple therapy had a significantly higher risk of all-cause mortality compared to those on initial dual therapy (Adjusted HR: 1.14; 95% CI: 1.08–1.20; p < 0.001). There was no significant difference in the risk of MACE between the initial triple therapy and initial dual therapy groups. In this real-world retrospective database study, MACEs are not uncommon among patients with COPD. Initial triple therapy was not associated with an increased risk of major adverse cardiovascular events compared with initial dual bronchodilator therapy in patients with COPD.