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Effects of Cardiovascular drugs on Mortality in Severe Chronic Obstructive Pulmonary Disease A Time-Dependent Analysis

Ekström, Magnus LU orcid ; Hermansson, Anna Bornefalk and Ström, Kerstin LU (2013) In American Journal of Respiratory and Critical Care Medicine 187(7). p.715-720
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. Objectives: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias. Methods: Prospective national study of patients starting long-term oxygen therapy 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, Pa-O2, Pa-CO2, World Health Organization performance status, body mass index, comorbidity, and concomitant medications.... (More)
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. Objectives: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias. Methods: Prospective national study of patients starting long-term oxygen therapy 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, Pa-O2, Pa-CO2, World Health Organization 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 and Main Results: Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, antiplatelet drugs, beta-blockers, and statins on all-cause mortality were measured. 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 for antiplatelet drugs (hazard ratio [HR], 0.86; 95% CI, 0.75-0.99; P = 0.030) and trends for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 0.90; 95% CI, 0.79-1.04; P = 0.166) and statins (HR, 0.86; 95% CI, 0.72-1.03; P = 0.105), whereas beta-blockers increased mortality (HR, 1.19; 95% CI, 1.04-1.37; P = 0.010). Conclusions: This study supports that antiplatelet drugs improve survival (Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic obstructive pulmonary disease, long-term oxygen therapy, survival, comorbidity
in
American Journal of Respiratory and Critical Care Medicine
volume
187
issue
7
pages
715 - 720
publisher
American Thoracic Society
external identifiers
  • wos:000317316200012
  • scopus:84875821385
  • pmid:23328521
ISSN
1535-4970
DOI
10.1164/rccm.201208-1565OC
language
English
LU publication?
yes
id
defb74b7-d286-430c-9ecd-5414f0c3c43d (old id 3745253)
date added to LUP
2016-04-01 10:17:35
date last changed
2022-03-27 06:53:24
@article{defb74b7-d286-430c-9ecd-5414f0c3c43d,
  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. Objectives: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias. Methods: Prospective national study of patients starting long-term oxygen therapy 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, Pa-O2, Pa-CO2, World Health Organization 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 and Main Results: Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, antiplatelet drugs, beta-blockers, and statins on all-cause mortality were measured. 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 for antiplatelet drugs (hazard ratio [HR], 0.86; 95% CI, 0.75-0.99; P = 0.030) and trends for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 0.90; 95% CI, 0.79-1.04; P = 0.166) and statins (HR, 0.86; 95% CI, 0.72-1.03; P = 0.105), whereas beta-blockers increased mortality (HR, 1.19; 95% CI, 1.04-1.37; P = 0.010). Conclusions: This study supports that antiplatelet drugs improve survival}},
  author       = {{Ekström, Magnus and Hermansson, Anna Bornefalk and Ström, Kerstin}},
  issn         = {{1535-4970}},
  keywords     = {{chronic obstructive pulmonary disease; long-term oxygen therapy; survival; comorbidity}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{715--720}},
  publisher    = {{American Thoracic Society}},
  series       = {{American Journal of Respiratory and Critical Care Medicine}},
  title        = {{Effects of Cardiovascular drugs on Mortality in Severe Chronic Obstructive Pulmonary Disease A Time-Dependent Analysis}},
  url          = {{http://dx.doi.org/10.1164/rccm.201208-1565OC}},
  doi          = {{10.1164/rccm.201208-1565OC}},
  volume       = {{187}},
  year         = {{2013}},
}