A Canadian study shows that long-acting beta agonists (LABA) and long-acting anticholinergics, commonly used therapeutic agents for chronic obstructive pulmonary disease (COPD), are associated with an elevated risk of cardiovascular events. The paper was published online May 21 in JAMA Internal Medicine. The study identified more than 191,000 patients aged 66 years or older who had been treated for COPD for more than 5 years through a healthcare database. 28% (53,532) of patients had emergency admissions for acute coronary syndrome (ACS), heart failure, ischemic stroke, or arrhythmias. All COPD patients were analyzed after matching with non-COPD patients. The results showed that LABA and long-acting anticholinergic drugs had the highest risk of events 2 to 3 weeks after initiation and that there were no differences between drugs. Newly prescribed LABA and long-acting anticholinergic drugs were associated with a 31% increased risk of cardiovascular events. When cardiovascular endpoints were assessed separately, the risk of ACS and heart failure was elevated, but arrhythmias and stroke were not. In fact, long-acting anticholinergics were protective against ischemic stroke, whereas LABAs did not have this effect. Several experts commenting on the study said that patients on long-acting bronchodilators need to be monitored closely because both LABA and long-acting anticholinergics are the mainstay of COPD treatment and there is no other drug that can slow disease progression. The association between long-acting bronchodilators and cardiovascular events was confirmed in the POET-COPD randomized controlled study and in a previous small study, and the ongoing TIOSPIR safety study may explain the relative risks of different COPD treatment agents.