Abstract 17611: Leukotriene Modifiers and the Risk of Coronary Events in Patients With Underlying Coronary Heart Disease
Background: Inflammation is common feature of atherosclerosis. Due to their anti-inflammatory properties, leukotriene (LT) modifiers may inhibit the underlying inflammatory disease process active in atherosclerosis. They were described as having a plaque stabilizing effect that may reduce coronary events.
Objectives: To compare LT modifiers to other respiratory agents in patients with underlying coronary heart disease with regard to the risk of coronary events.
METHODS: Study participants were Medicare beneficiaries ≥ 65 years who initiated therapy with a LT modifier or a fixed combination of an inhaled corticosteroid and a long acting beta agonist (ICS/LABA), and had a recorded diagnosis of coronary heart diseases at baseline. Propensity score (PS) matched analyses were used to balance all baseline characteristics and evaluate the risk of a coronary event (defined as hospitalization for myocardial infarction, acute coronary syndrome, or cardiac revascularization procedure) among initiators of LT modifiers and ICS/LABA combinations.
RESULTS: We identified 4,554 patients who initiated LT modifiers and 13,821 patients who initiated ICS/LABA between 2001-2008. A PS-matched analysis including 88 covariates yielded a matched population of 7,598 initiators with balanced baseline characteristics. The rate ratio (RR) for a coronary event associated with LT modifiers vs. ICS/LABA combinations during a follow-up period of 180 days was 0.93 (95% CI, 0.75, 1.15). After adjusting for additional 500 covariates in a high-dimensional PS-matched analysis including 7,250 initiators, the RR moved to 0.84 (95% CI, 0.68, 1.03).
Conclusions: Our data are compatible with a mild but clinically relevant reduction in the risk of coronary events in patients with coronary heart disease initiating LT modifiers vs. ICS/LABA combinations. Larger studies are necessary to narrow confidence intervals and to conduct subgroup analyses by age and cardiovascular risk.
- © 2013 by American Heart Association, Inc.