Renin-angiotensin-system inhibitors and the risk of exacerbations in chronic obstructive pulmonary disease: a nationwide registry study
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Renin-angiotensin-system inhibitors and the risk of exacerbations in chronic obstructive pulmonary disease : a nationwide registry study. / Vilstrup, Frida; Heerfordt, Christian Kjer; Kamstrup, Peter; Hedsund, Caroline; Biering-Sørensen, Tor; Sørensen, Rikke; Kolekar, Shailesh; Hilberg, Ole; Pedersen, Lars; Lund, Thomas Kromann; Klausen, Tobias Wirenfeldt; Skaarup, Kristoffer Grundtvig; Eklöf, Josefin; Sivapalan, Pradeesh; Jensen, Jens Ulrik Stæhr.
In: BMJ Open Respiratory Research, Vol. 10, No. 1, e001428, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Renin-angiotensin-system inhibitors and the risk of exacerbations in chronic obstructive pulmonary disease
T2 - a nationwide registry study
AU - Vilstrup, Frida
AU - Heerfordt, Christian Kjer
AU - Kamstrup, Peter
AU - Hedsund, Caroline
AU - Biering-Sørensen, Tor
AU - Sørensen, Rikke
AU - Kolekar, Shailesh
AU - Hilberg, Ole
AU - Pedersen, Lars
AU - Lund, Thomas Kromann
AU - Klausen, Tobias Wirenfeldt
AU - Skaarup, Kristoffer Grundtvig
AU - Eklöf, Josefin
AU - Sivapalan, Pradeesh
AU - Jensen, Jens Ulrik Stæhr
N1 - Publisher Copyright: © 2023 Author(s). Published by BMJ.
PY - 2023
Y1 - 2023
N2 - Objective The renin-angiotensin system (RAS) has been shown to play a role in the pathogenesis of chronic obstructive pulmonary disease (COPD) because of the inflammatory properties of the system. Many patients with COPD use RAS-inhibiting (RASi) treatment. The aim was to determine the association between treatment with RASi and the risk of acute exacerbations and mortality in patients with severe COPD. Methods Active comparator analysis by propensity-score matching. Data were collected in Danish national registries, containing complete information on health data, prescriptions, hospital admissions and outpatient clinic visits. Patients with COPD (n=38 862) were matched by propensity score on known predictors of the outcome. One group was exposed to RASi treatment (cases) and the other was exposed to bendroflumethiazide as an active comparator in the primary analysis. Results The use of RASi was associated with a reduced risk of exacerbations or death in the active comparator analysis at 12 months follow-up (HR 0.86, 95% CI 0.78 to 0.95). Similar results were evident in a sensitivity analysis of the propensity-score-matched population (HR 0.89, 95% CI 0.83 to 0.94) and in an adjusted Cox proportional hazards model (HR 0.93, 95% CI 0.89 to 0.98). Conclusion In the current study, we found that the use of RASi treatment was associated with a consistently lower risk of acute exacerbations and death in patients with COPD. Explanations to these findings include real effect, uncontrolled biases, and - less likely - chance findings.
AB - Objective The renin-angiotensin system (RAS) has been shown to play a role in the pathogenesis of chronic obstructive pulmonary disease (COPD) because of the inflammatory properties of the system. Many patients with COPD use RAS-inhibiting (RASi) treatment. The aim was to determine the association between treatment with RASi and the risk of acute exacerbations and mortality in patients with severe COPD. Methods Active comparator analysis by propensity-score matching. Data were collected in Danish national registries, containing complete information on health data, prescriptions, hospital admissions and outpatient clinic visits. Patients with COPD (n=38 862) were matched by propensity score on known predictors of the outcome. One group was exposed to RASi treatment (cases) and the other was exposed to bendroflumethiazide as an active comparator in the primary analysis. Results The use of RASi was associated with a reduced risk of exacerbations or death in the active comparator analysis at 12 months follow-up (HR 0.86, 95% CI 0.78 to 0.95). Similar results were evident in a sensitivity analysis of the propensity-score-matched population (HR 0.89, 95% CI 0.83 to 0.94) and in an adjusted Cox proportional hazards model (HR 0.93, 95% CI 0.89 to 0.98). Conclusion In the current study, we found that the use of RASi treatment was associated with a consistently lower risk of acute exacerbations and death in patients with COPD. Explanations to these findings include real effect, uncontrolled biases, and - less likely - chance findings.
KW - COPD epidemiology
KW - COPD Exacerbations
KW - COPD Pathology
KW - COPD Pharmacology
UR - http://www.scopus.com/inward/record.url?scp=85149529096&partnerID=8YFLogxK
U2 - 10.1136/bmjresp-2022-001428
DO - 10.1136/bmjresp-2022-001428
M3 - Journal article
C2 - 36882221
AN - SCOPUS:85149529096
VL - 10
JO - B M J Open Respiratory Research
JF - B M J Open Respiratory Research
SN - 2052-4439
IS - 1
M1 - e001428
ER -
ID: 340409641