Heart Disease vs Lung Disease: Can We All Get Along?

Primary Care Blog

A bit of medical humor: Ask a cardiologist about the purpose of the body and s/he will tell you it's to support the function of the heart.  Ask a pulmonologist about the purpose of the body and s/he will tell it's to support the function of the lungs.  This reminds of the late Rodney King's immortal quote, "Can we all get along?".  I mention this because it often comes down to the primary care provider, a family physician or general internist, to help a patient torn between two opposing therapeutic regimens.  For instance, beta blockers are often used in those with heart disease but their antithesis, beta agonists, are used in common lung diseases.  But patients often have both conditions, which then begs the question, "Which medication should I use, doc?"

In a nested case-control analysis of a retrospective cohort study published early online last week in JAMA Internal Medicine, the authors noted that new use of long-acting beta agonists and anticholinergics in older patients with chronic obstructive pulmonary disease was associated with an increase in cardiovascular events.  The authors arrived at their conclusion by finding 191,005 patients w/COPD and compared those who'd recently been prescribed a LABA and/or LAA to controls who were not prescribed either medication.  The former were more likely to be hospitalized for a cardiovascular event soon after starting their LABA +/- LAA.  Of note, all were older than 65yo.

So, what does this mean for you & me?  First, we can't live w/o our heart.  Second, we can't live w/o our lungs.  Duh, right?  But the fact remains that taking medications considered standard of care for COPD has just been linked to an increase in heart disease events.  Granted this study doesn't prove cause & effect.  However, it does raise some grave concerns.  At the very least, we need to monitor our patients more closely.  And until more evidence is published, we'll need to include cardiovascular events in our discussion regarding new use of LABAs & LAAs.

Alvin B. Lin, MD, FAAFP

Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.