Cardiovascular events in patients with COPD: TORCH study results.
BACKGROUND
Previous studies have suggested that long-term use of beta agonists to treat chronic obstructive pulmonary disease (COPD) may increase the risk of cardiovascular adverse events. In this post hoc analysis, data from the TOwards a Revolution in COPD Health (TORCH) study were used to investigate whether use of the long-acting beta(2) agonist salmeterol over 3 years increased the risk of cardiovascular adverse events in patients with moderate to severe COPD.


METHODS
TORCH was a randomised, double-blind, placebo controlled study conducted at 444 centres in 42 countries. Patients (n=6184; safety population) received twice daily combined salmeterol 50 microg plus fluticasone propionate 500 microg (SFC), either component alone, or placebo. Adverse events were recorded every 12 weeks for 3 years.


RESULTS
The probability of having a cardiovascular adverse event by 3 years was 24.2% for placebo, 22.7% for salmeterol, 24.3% for fluticasone propionate and 20.8% for SFC. Although a history of myocardial infarction doubled the probability of cardiovascular adverse events, the event rates remained similar across treatment groups.


CONCLUSIONS
Post hoc analysis of the 3-year TORCH dataset showed that salmeterol alone or in combination (SFC) did not increase the risk of cardiovascular events in patients with moderate to severe COPD.
Calverley
Peter M A
PM
Department of Medicine, University Hospital Aintree, Longmoor Lane, Liverpool, UK. pmacal@liverpool.ac.uk
Anderson
Julie A
JA
Celli
Bartolome
B
Ferguson
Gary T
GT
Jenkins
Christine
C
Jones
Paul W
PW
Crim
Courtney
C
Willits
Lisa R
LR
Yates
Julie C
JC
Vestbo
Jørgen
J
D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000009:adverse effects / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000009:adverse effects; D001993:Bronchodilator Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D000068299:Salmeterol Xinafoate
D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol