{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:08:57Z","timestamp":1785326937898,"version":"3.55.0"},"reference-count":32,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Committee at Herlev and Gentofte University Hospital","award":["193o"],"award-info":[{"award-number":["193o"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Cardiovascular disease is a major comorbidity in chronic obstructive pulmonary disease (COPD). Previous studies evaluating the association between inhaled corticosteroids (ICS) and cardiovascular events (CVEs) in COPD have yielded conflicting results and a potential dose\u2013response relationship remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the association between ICS exposure and risk of CVE in COPD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this nationwide, retrospective register-based cohort study, we included patients with a specialist-verified COPD diagnosis between January 2008 and January 2022. ICS exposure was quantified as mean daily budesonide-equivalent dose redeemed in the year prior to index and categorised as none, low (&gt;0\u2009\u00b5g\/day and &lt;400\u2009\u00b5g\/day), moderate (400\u2013800\u2009\u00b5g\/day) or high (&gt;800\u2009\u00b5g\/day). We assessed CVE risk using adjusted cause-specific Cox proportional hazards models, with additional sensitivity analyses including a complete-case analysis, time-varying Cox regression, Fine-Gray competing risk model, and a negative control outcome analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 82\u2009327 patients, 8948 (10.9 %) experienced a CVE during a 1-year follow-up. In the primary analysis, low- and moderate-dose ICS was associated with a significantly reduced CVE rate compared with no ICS use. A modest decrease in CVE rate was observed for moderate-dose ICS largely across all sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICS use in COPD was not associated with an increased risk of CVE at any dose level. A modest association with reduction in CVE risk was confined to moderate-dose ICS. These findings support the cardiovascular safety of ICS and reinforce that ICS prescribing should be guided by exacerbation risk and symptom burden rather than cardiovascular concern.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123317","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:45:33Z","timestamp":1785325533000},"page":"e123317","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Inhaled corticosteroids and risk of cardiovascular events in chronic obstructive pulmonary disease: a nationwide cohort study in Denmark"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6776-5468","authenticated-orcid":false,"given":"Mia Ritzau Ish\u00f8j","family":"Nielsen","sequence":"first","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7676-7069","authenticated-orcid":false,"given":"Emma","family":"Borremose Wedervang","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Kubel","family":"Vognsen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4784-4696","authenticated-orcid":false,"given":"Karen Hougaard","family":"Frost","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Ryder","family":"Jordan","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid Anna Aalberg","family":"Vikjord","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Occupational Medicine, St. Olavs University Hospital, Trondheim, Norway"},{"name":"Department of Community Medicine and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4675-9616","authenticated-orcid":false,"given":"Alexander G","family":"Mathioudakis","sequence":"additional","affiliation":[{"name":"Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester School of Biological Sciences, Manchester, UK"},{"name":"North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Ulrik St\u00e6hr","family":"Jensen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-3655","authenticated-orcid":false,"given":"Pradeesh","family":"Sivapalan","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2026072904452626000_16.7.e123317.1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S2213-2600(24)00339-4","article-title":"The global burden of COPD: epidemiology and effect of prevention strategies","volume":"13","author":"de Oca","year":"2025","journal-title":"Lancet Respir Med"},{"key":"2026072904452626000_16.7.e123317.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.76"},{"key":"2026072904452626000_16.7.e123317.3","doi-asserted-by":"crossref","unstructured":"Ragnoli B , Chiazza F , Tarsi G , et al . 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