Short-term oral corticosteroid use and risk for major adverse cardiovascular events within one year in patients with chronic obstructive pulmonary disease, a Danish registry-based cohort study

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) often require treatment with oral corticosteroids (OCS). While OCS can improve forced expiratory volume in first second (FEV1) in the short term, there are still concerns about their potential cardiovascular adverse effects. Evidence on whether short-term OCS use increases the risk of major adverse cardiovascular events (MACE) remains lacking. Hypothesis: We hypothesized that short-term OCS use in patients with COPD would be associated with an increased one-year risk of MACE compared with antibiotic treatment alone. Methods: We conducted a registry-based, nationwide cohort study in outpatients diagnosed with COPD in the Danish Register of COPD (DrCOPD) between 2010 and 2022. Exposure was defined as prescription of OCS and antibiotics for respiratory infections in the year before baseline (defined as DrCOPD entry). Exposed patients were propensity score matched on clinical parameters to patients prescribed antibiotics for respiratory infections but no OCS. The primary outcome was all MACE, as a composite outcome, within 365 days following baseline. Results: A total of 4,666 patients were included. Short-term OCS exposure was not associated with increased risk of MACE during one-year follow-up compared to use of antibiotics for respiratory infections (hazard ratio = 0.84, 95% CI 0.66–1.07, p = 0.17). The findings were consistent in a sensitivity analysis using an adjusted Cox model in the unmatched population. Secondary analyses of individual MACE components showed no significant differences in risk. An additional sensitivity analysis stratified by cumulative OCS dose revealed no dose-response relationship for the primary outcome (all MACE). Conclusion: Short-term OCS use was not associated with an increased risk of MACE within 365 days among outpatients with COPD.