Corticosteroid use and the risk of acute myocardial infarction in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) use medications known to have cardiovascular effects. Yet, the burden of cardiovascular disease in COPD and the effect of corticosteroids used in its treatment have not been described. We used the Saskatchewan health services database to form a population-based cohort of 5648 patients treated for COPD and followed during 1990-99. Cardiovascular morbidity and mortality were higher in our cohort than in the general population (Standardized Rate Ratio=l .9 and 2.0 respectively). Ischemic heart disease (19.6 per 1000 person-years) was a more frequent cause of death than COPD itself (15.5 per 1000 person-years). In a nested case-control analysis, doses of oral corticosteroids larger than 5 mg of prednisone per day increased the risk of AMI (Rate Ratio=l .81 ; 95%CI 1.05 -3.13). However, a réduction of the risk of AMI was observed with doses of inhaled corticosteroids ranging from 50 to 200 micrograms per day (Rate Ratio= 0.68; 95%CI 0.47 - 0.99). The burden of cardiovascular disease in COPD patients may be greater than that of the lung disease itself. The effects of corticosteroids on the cardiovascular system should be taken into account