Effects of Cardiovascular Drugs on Mortality in Severe COPD: A Time-Dependent Analysis.
Am J Respir Crit Care Med. 2013 Jan 17;
Authors: Ekstr�m MP, Bornefalk Hermansson A, Str�m KE
Abstract
RATIONALE: Cardiovascular drugs may improve survival in Chronic Obstructive Pulmonary Disease (COPD). However, previous studies did not account for major sources of bias and drug effects have not been evaluated in severe COPD. OBJECTIVE: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias. DESIGN, SETTING AND PATIENTS: Prospective national study of patients starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1 October 2005 and 30 June 2009. Effects on mortality were estimated using extended Cox regression adjusted for age, sex, PaO2, PaCO2, WHO performance status, body mass index, comorbidity and concomitant medications. Immortal and immeasurable time bias was addressed by analyzing all medications as time-dependent variables and accounting for hospitalized time, respectively. MEASUREMENTS: Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), antiplatelet drugs, beta blockers, and statins on all-cause mortality. RESULTS: Of the 2,249 included patients, 1,129 (50%) died under observation. No patient was lost to follow-up. The adjusted time-dependent model was compatible with reduced mortality (hazard ratio (HR); 95% confidence interval) for antiplatelet drugs (HR 0.86; 0.75 to 0.99; P=0.030) and trends for ACEI/ARB (HR 0.90; 0.79 to 1.04; P=0.166) and statins (HR 0.86; 0.72 to 1.03; P=0.105), whereas beta blockers increased mortality (HR 1.19; 1.04 to 1.37; P=0.010). CONCLUSIONS: This study supports that antiplatelet drugs improve survival, whereas beta blockers decrease survival in oxygen-dependent COPD.
PMID: 23328521 [PubMed - as supplied by publisher]
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