The incidence of ischemic cardiac events in patients with mild chronic obstructive pulmonary disease is reduced with treatment with inhaled budesonide, according to findings published in the June issue of the European Respiratory Journal.

Dr. Claes-Goran Lofdahl, of University Hospital, Lund, Sweden, and colleagues conducted a post hoc analysis of the European Respiratory Society’s study on Chronic Obstructive Pulmonary Disease (EUROSCOP), a 3-year, placebo-controlled study of budesonide in smokers (mean age 52 years) with mild COPD.

The aim of the analysis was to determine whether long-term treatment with budesonide (800 mcg/day) attenuates the incidence of ischemic cardiac events — angina pectoris, myocardial infarction, coronary artery disorder, or myocardial ischemia.

Among the 1175 patients included in the analysis, 18 (3.0%) budesonide-treated patients experienced at least one ischemic cardiac event during the 3-year study, compared with 31 (5.3%) placebo-treated patients (p = 0.048). Patients treated with budesonide experienced a total of 22 ischemic cardiac events, compared with 38 events in the placebo group, for an event rate ratio of 0.58.

Thirty of the 60 reported ischemic cardiac events were serious, with 13 of them occurring in the budesonide group and 17 in the placebo group.

"The cause behind the association between COPD and cardiovascular disease is still unknown but one explanation could be that the systemic inflammation in COPD increases the risk for cardiovascular events," Dr. Lofdahl’s team writes. "Elevated CRP levels, a marker of inflammation that is associated with reduced lung function, are also associated with ischemic cardiac disease," they note.

"Thus, it would be plausible that inhaled steroids, such as budesonide, reduce the local inflammation and subsequent cardiovascular morbidity," the investigators suggest.