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Multicenter Study
. 2024 Jun 4;13(11):e033882.
doi: 10.1161/JAHA.123.033882. Epub 2024 May 31.

Chronic Obstructive Pulmonary Disease Exacerbations Increase the Risk of Subsequent Cardiovascular Events: A Longitudinal Analysis of the COPDGene Study

Han-Mo Yang  1   2   3 , Min Hyung Ryu  1   2 , Vincent J Carey  1   2 , Gregory L Kinney  4 , John E Hokanson  4 , Mark T Dransfield  5 , Craig P Hersh  1   6   2 , Edwin K Silverman  1   6   2 ; COPDGene Investigators †
Collaborators, Affiliations
Multicenter Study

Chronic Obstructive Pulmonary Disease Exacerbations Increase the Risk of Subsequent Cardiovascular Events: A Longitudinal Analysis of the COPDGene Study

Han-Mo Yang et al. J Am Heart Assoc. .

Abstract

Background: Cardiovascular disease (CVD) is the most important comorbidity in patients with chronic obstructive pulmonary disease (COPD). COPD exacerbations not only contribute to COPD progression but may also elevate the risk of CVD. This study aimed to determine whether COPD exacerbations increase the risk of subsequent CVD events using up to 15 years of prospective longitudinal follow-up data from the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study.

Methods and results: The COPDGene study is a large, multicenter, longitudinal investigation of COPD, including subjects at enrollment aged 45 to 80 years with a minimum of 10 pack-years of smoking history. Cox proportional hazards models and Kaplan-Meier survival curves were used to assess the risk of a composite end point of CVD based on the COPD exacerbation rate. Frequent exacerbators exhibited a higher cumulative incidence of composite CVD end points than infrequent exacerbators, irrespective of the presence of CVD at baseline. After adjusting for covariates, frequent exacerbators still maintained higher hazard ratios (HRs) than the infrequent exacerbator group (without CVD: HR, 1.81 [95% CI, 1.47-2.22]; with CVD: HR, 1.92 [95% CI, 1.51-2.44]). This observation remained consistently significant in moderate to severe COPD subjects and the preserved ratio impaired spirometry population. In the mild COPD population, frequent exacerbators showed a trend toward more CVD events.

Conclusions: COPD exacerbations are associated with an increased risk of subsequent cardiovascular events in subjects with and without preexisting CVD. Patients with COPD experiencing frequent exacerbations may necessitate careful monitoring and additional management for subsequent potential CVD.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00608764.

Keywords: COPD exacerbation; cardiovascular events; chronic obstructive pulmonary disease; clinical epidemiology; preserved ratio impaired spirometry.

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Figures

Figure 1
Figure 1. Study flow diagram.
From all eligible participants (n=10 652) enrolled in COPDGene Phase I, those who subsequently underwent lung transplantation or lung volume reduction surgery, who had no smoking history, or who lacked longitudinal follow‐up data, were excluded. Furthermore, subjects with normal baseline spirometry (n=3801) were also excluded. The remaining study population (n=5083) was subdivided based on spirometry and GOLD spirometric classification. Each subgroup was further classified into groups with or without CVD at baseline. CVD includes coronary artery disease, congestive heart failure, stroke, transient ischemic attack, peripheral vascular disease, angina, heart attack, and history of coronary artery angioplasty or coronary artery bypass graft surgery. COPD indicates chronic obstructive pulmonary disease; COPDGene, Genetic Epidemiology of Chronic Obstructive Pulmonary Disease; CVD, cardiovascular disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; and PRISm, preserved ratio impaired spirometry.
Figure 2
Figure 2. Kaplan‐Meier plots for the cumulative incidence of a composite cardiovascular disease end point in the entire study population (GOLD 1–4 and PRISm) and in GOLD 2 to 4 subjects only.
CVD events include coronary artery disease, stroke, heart attack, coronary artery angioplasty, coronary artery bypass graft surgery, and peripheral artery disease. Cumulative incidence in the GOLD 1 to 4 and PRISm populations without CVD at baseline (A) and with CVD at baseline (B). Cumulative incidence in the GOLD 2 to 4 subjects without CVD at baseline (C) and with CVD at baseline (D). Cumulative incidence in the GOLD 2 to 4 subjects without CVD at baseline, using a dichotomous indicator variable for only severe exacerbations (requiring emergency room visit and/or hospitalization) instead of moderate/severe exacerbations (E) and with CVD at baseline (F). The P values in the graphs represent the log‐rank test results. CVD indicates cardiovascular disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; and PRISm, preserved ratio impaired spirometry.
Figure 3
Figure 3. Kaplan‐Meier plots for the cumulative incidence of a composite cardiovascular end point separately in the GOLD 1 and the PRISm populations.
Cumulative incidence in the PRISm subjects without CVD at baseline (A) and with CVD at baseline (B). Cumulative incidence in the GOLD 1 subjects without CVD at baseline (C) and with CVD at baseline (D). The P values in the graphs are for the log‐rank test. Cardiovascular events include coronary artery disease, stroke, heart attack, coronary artery angioplasty, coronary artery bypass graft surgery, and peripheral artery disease. CVD indicates cardiovascular disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; and PRISm, preserved ratio impaired spirometry.
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References

    1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global burden of cardiovascular diseases and risk factors, 1990‐2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010 - DOI - PMC - PubMed
    1. Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto‐Plata V, Zulueta J, Cabrera C, Zagaceta J, Hunninghake G, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186:155–161. doi: 10.1164/rccm.201201-0034OC - DOI - PubMed
    1. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1418–1422. doi: 10.1164/ajrccm.157.5.9709032 - DOI - PubMed
    1. Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E Jr, She D. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16:63–70. doi: 10.1016/j.annepidem.2005.04.008 - DOI - PubMed
    1. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32:962–969. doi: 10.1183/09031936.00012408 - DOI - PubMed

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