A nested case-control study of more than 284,000 individuals with chronic obstructive pulmonary disease (COPD) suggests that new initiation of long-acting inhaled bronchodilators is associated with an increased severe cardiovascular risk within 30 days of therapy initiation. The study, from researchers at Taiwan's National Defense Medical Center, investigated the risk of cardiovascular disease (CVD) associated with inhaled long-acting ß2-agonists (LABAs) or long-acting antimuscarinic antagonists (LAMAs), focusing on the initiation and duration of LABA and LAMA therapies. During a mean followup of 2 years, a total of 37,719 patients with CVD and 146,139 matched controls were identified. New use of LABAs and LAMAs in COPD was linked to a 1.50-fold and 1.52-fold greater cardiovascular risk within 30 days of initiation, respectively; but the risk was absent, or even reduced, with prevalent use of these medications. The results were unaffected by patients' baseline CVD status. Based on their findings, the researchers urge doctors to carefully monitor new users of LABAs or LAMAs for symptoms of CVD.