The Effects of Long-Term Bronchodilators and Inhaled Corticosteroids in COPD Patients on the Risk of Cardiovascular Events: Literature Review

Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, manifesting as a systemic disorder marked by persistent inflammation, oxidative stress, and metabolic dysfunction that closely link it to cardiovascular diseases (CVD) such as ischemic heart disease, heart failure, arrhythmia, and stroke. Shared risk factors, overlapping pathophysiological mechanisms including endothelial dysfunction and autonomic imbalance, and the impact of COPD exacerbations synergistically elevate the risk of major adverse cardiovascular events (MACE), especially within critical post-exacerbation windows. Long-acting bronchodilators (LABA, LAMA) and inhaled corticosteroids (ICS) form the cornerstone of COPD management, with extensive evidence from randomized trials, meta-analyses, and real-world cohorts demonstrating their cardiovascular safety and, in some contexts, protective effects via inflammation suppression. Triple therapy (ICS/LAMA/LABA) is recommended as first-line for high-risk COPD phenotypes characterized by frequent exacerbations and cardiovascular comorbidity, showing superiority in reducing severe cardiopulmonary events and all-cause mortality. Despite concerns of transient cardiovascular risks during treatment initiation, robust cumulative data affirm the long-term safety profile of these inhaled therapies, underpinning individualized, phenotype-driven treatment strategies to mitigate COPD’s cardiovascular burden and improve clinical outcomes.