COPD-CVD link extends beyond MI and stroke

  • Thorax
  • 12 Feb 2018

  • from Dawn O'Shea
  • Clinical Summaries
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Takeaway

  • Increased risks for cardiovascular disease (CVD) in people with COPD are not confined to myocardial infarction (MI) and stroke but exist across the spectrum of CVD subtypes.

Why this matters

  • Investigation of CVD risks in people with COPD has focused on coronary heart disease (CHD), in particular MI and stroke.
  • Risks for other CVDs such as angina, afib, heart failure and diseases of the arterial circulation are less well documented, but the evidence is accumulating that these too are elevated in COPD.
  • The findings presented here provide a strong case for more aggressive management of CVD risks in COPD beyond MI and stroke.
  • The study adds to the growing body of evidence supporting a more integrated approach to the diagnosis and management of lung and heart disease, which targets those in middle to late-middle age.

Key result

  • The prevalence of COPD was 2%-3%.
  • Relative risks for all CVD subtypes decreased with increasing age, especially for afib, heart failure, CHD (angina, MI) and stroke outcomes.
  • In crude analysis (adjusting for matching variables only), there was no evidence of an association between COPD and any of the 4 stroke outcomes in the oldest age group.
  • For all other outcomes, the excess risk was evident at all ages.
  • For most CVD outcomes, relative risks remained unchanged over the study period.

Study design

  • Matched cohort study of patients with a GP diagnosis of COPD prior to 31 December 2015 using data from the UK Clinical Practice Research Datalink.
  • Funding: British Lung Foundation.

Limitations

  • Difficulties characterising smoking status.
  • Differential misclassification of CVD outcomes.
  • Lack of adjustment for other potential confounders.