Polymorbidity is an important component of chronic obstructive pulmonary disease (COPD), with cardiovascular diseases being among the most important comorbidities.1 The development of both incident and recurrent cardiovascular events is related to the degree of lung function impairment in COPD.2 Acute exacerbations of COPD (AECOPD) are associated with a higher risk of developing an acute cardiovascular event, particularly in the first 6 months following the AECOPD.3 4

Therapies that include inhaled corticosteroids (ICS) decrease the risk of exacerbations.5 6 Thus, it would follow that therapies that decrease exacerbations, such as those include ICS, would decrease cardiovascular events. This was the topic for the Study to Understand Mortality and Morbidity in COPD trial, a 3-year trial of over 16 000 patients randomised into four groups (placebo, fluticasone furoate, vilanterol and fluticasone/vilanterol).7 The ICS-containing groups had fewer exacerbations and less lung function decline but did not significantly decrease mortality or cardiovascular events. Cardiopulmonary events are the focus for ‘A Randomised, Double-Blind, Parallel Group, Multicentre, Phase III Study to Assess the Efficacy of Budesonide, Glycopyrronium and Formoterol Fumarate Metered Dose Inhaler Relative to Glycopyrronium and Formoterol Fumarate MDI on Cardiopulmonary Outcomes in COPD (THARROS)’, which is currently recruiting up to 5000 patients with an estimated completion in 2028.8 The …