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Amegadzie JE, Gao Z, Quint JK, Russell R, Hurst JR, Lee TY, Sin DD, Chen W, Bafadhel M, Sadatsafavi M. QRISK3 underestimates the risk of cardiovascular events in patients with COPD. Thorax 2023:thorax-2023-220615. [PMID: 38050168 DOI: 10.1136/thorax-2023-220615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied. METHODS We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998-July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool. RESULTS 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54-1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted). CONCLUSION People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.
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Affiliation(s)
- Joseph Emil Amegadzie
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zhiwei Gao
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer K Quint
- School of Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Richard Russell
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- King's Centre of Lung Health, Peter Gorer Dept of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - John R Hurst
- Academic Unit of Respiratory Medicine, University College London Medical School, London, UK
| | - Tae Yoon Lee
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mona Bafadhel
- King's Centre of Lung Health, Peter Gorer Dept of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
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Ren X, Wang S, Lian J, Pan C, Li B, He Y, Zhao J, Wang D, Luo Z, Shen J, Sun Z, Hou Y, Qi L, Lu Q, Lv P, Wang Y, Yong Q. Interrelation of Chronic Lung Disease and Cardiovascular Disease Based on Two National Prospective Cohort Studies. Heart Lung Circ 2023; 32:1167-1177. [PMID: 37574417 DOI: 10.1016/j.hlc.2023.06.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Chronic lung diseases (CLDs) and cardiovascular diseases (CVDs) are the main chronic diseases responsible for a considerable burden of disease. This study aimed to estimate the interrelation of CLDs and CVDs using two Chinese national longitudinal cohort studies. METHODS The China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS) were used in this study with 15,052 and 9,765 participants, respectively. The Cox proportional risk model was used to estimate the interrelation between CLDs and CVDs. Mediating effects were performed to detect possible influencing pathways between CLDs and CVDs. RESULTS The association of CLDs with CVDs was identified in 1,647 participants (10.9%) with newly diagnosed CVDs in CHARLS and 332 participants (11.6%) in CLHLS. The Cox proportional risk model showed that CLDs were a significant predictor of CVDs (HR 1.49, 95% CI 1.27-1.76) after adjusting for covariates, and the hazard ratios of stroke and CVDs excluding stroke were (HR 1.02, 95% CI 0.79-1.31) and (HR 1.76, 95% CI 1.46-2.13), respectively. These association were mediated by body mass index (BMI) and Center for Epidemiological Studies Depression Scale (CES-D-10) scores. No significant association was found in CHARLS and CLHLS regarding CVDs with CLDs. In CHARLS, CVDs was a significant predictor of CLDs (HR 1.40, 95% CI 1.09-1.79). CONCLUSIONS Chronic lung disease was associated with increased incidence of CVDs in middle-aged and older people in the community population and vice versa. Body mass index and depressive symptoms might be mediated by the effect of CLD on CVD.
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Affiliation(s)
- Xueling Ren
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junsong Lian
- Ninth Department of Healthcare, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chunjiang Pan
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Baobao Li
- State Key Laboratory of Highly Toxic Substances for Anti-Drug Research, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China
| | - Yan He
- Department of Occupational Disease Treatment, Medical Center of The Second Artillery, Beijing, China
| | - Jing Zhao
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dan Wang
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng Luo
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiangqiong Shen
- Department of Nursing, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhifeng Sun
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanka Hou
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Qi
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Lu
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Lv
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuling Wang
- Department of Nursing, Chinese PLA General Hospital, Beijing, China.
| | - Qinge Yong
- Department of Nursing, National Clinical Research Center for Geriatrics Diseases, The Second Medical Center of Chinese PLA General Hospital, Beijing, China.
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Clímaco DCS, Lustosa TC, de F P MV, Lins-Filho OL, Rodrigues VK, de Oliveira Neto LDAP, Feitosa ADM, Queiroga Júnior FJP, Cabral MM, Pedrosa RP. Is obstructive sleep apnea associated with increased arterial stiffness in patients with COPD? Sleep Breath 2022; 27:765-770. [PMID: 35538181 DOI: 10.1007/s11325-022-02635-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate arterial stiffness, a predictor of vascular damage was assessed by means of pulse wave velocity (PWV) in patients with chronic obstructive pulmonary disease (COPD) and comorbid obstructive sleep apnea (OSA), namely overlap syndrome (OS). METHODS Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography in the laboratory. A clinical assessment was performed according to a strict protocol, including two COPD questionnaires: the COPD assessment test and the modified Medical Research Council scale. COPD severity was graded according to the guidelines of the Global Initiative for Chronic Obstructive Lung Disease. Arterial stiffness was assessed by means of PWV, using a standard technique. RESULTS Of 102 patients with COPD, 51 had associated OSA. The OS group had more men than the COPD group (73% vs. 47%, respectively; p < 0.01). Both groups had similar ages (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Hypertension was found in 22% of COPD patients, as opposed to 17% patients in the OS group (p = 0.29). High PWV values were present in 42% of the patients. Patients with COPD and OS had the same PWV values (9.8 vs. 10.5 m/s, p = 0.34). There were no differences in central blood pressure, peripheral blood pressure, and augmentation index between the two groups (p > 0.05). CONCLUSION High PWV values were frequently observed in patients with COPD. However, there was no difference in PWV between patients with OS and those with COPD alone.
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Affiliation(s)
- Danielle Cristina Silva Clímaco
- Pulmonology Clinic, Hospital Otávio de Freitas, Rua Aprígio Guimarães s/n, Pernambuco, Tejipió, Recife, Brazil.
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil.
| | - Thais C Lustosa
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Marcus Vinícius de F P
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Ozeas L Lins-Filho
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Valesca Kehrle Rodrigues
- Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, s/n, Pernambuco, Santo Amaro, Recife, Brazil
| | | | - Audes Diógenes Magalhães Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | | | - Marília Montenegro Cabral
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
| | - Rodrigo P Pedrosa
- Laboratório Do Sono E Coração, Pronto Socorro Cardiológico de Pernambuco, (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, s/n, Santo Amaro, Recife, Brazil
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Association between Obstructive Lung Disease and Cardiovascular Disease: Results from the Vermont Diabetes Information System. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1030016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The association between obstructive lung disease and cardiovascular disease (CVD) has been suggested previously, but few studies have looked at this association in a diabetic cohort, a population highly susceptible to both comorbidities. A total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease and CVD. In a multivariate logistic regression model, obstructive lung disease was significantly associated with CVD, even after correcting for potential confounders, including gender, obesity, low income, cigarette smoking, alcohol problems, and high comorbidity (odds ratio = 1.96; 95% confidence interval 1.37–2.81; p < 0.01). All components of CVD, including coronary artery disease (CAD), congestive heart failure (CHF), peripheral vascular disease (PVD), and cerebrovascular accidents (CVA), were also significantly associated with obstructive lung disease. These data suggest an association between obstructive lung disease and CVD in patients with diabetes. Future studies are needed to identify the mechanism supporting this association
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Damkjær M, Håkansson K, Kallemose T, Ulrik CS, Godtfredsen N. Statins in High-Risk Chronic Obstructive Pulmonary Disease Outpatients: No Impact on Time to First Exacerbation and All-Cause Mortality - The STATUETTE Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:579-589. [PMID: 33707941 PMCID: PMC7943323 DOI: 10.2147/copd.s296472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Statins have, due to their anti-inflammatory properties, been suggested to potentially improve chronic obstructive pulmonary disease (COPD) outcomes. We aimed to investigate the effect of statins on time to first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods All outpatients with COPD seen at the Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Denmark in 2016 were identified and followed for 3.5 years in this retrospective, registry-based cohort study of time to first acute exacerbation of COPD (AECOPD) or death. AECOPD was defined as a rescue course of oral corticosteroid and/or hospital admission. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression. Results The cohort comprised 950 COPD outpatients, mean (SD) age 71 (11) years, and FEV1 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (1.68) and 211 patients (22%) had a history of hospital admission for AECOPD in the 12 months prior to index date. Three hundred and ninety-three patients (41.4%) were defined as statin users, with 131 (33.3%) having filled the first prescription for statin after index date. Statin use was not associated with reduced risk of AECOPD. When stratifying for moderate and severe exacerbations in a sub-analysis in the same model, statin use did not have an increased HR for exacerbation of either severity (HR = 1.02 (95% CI 0.85to 1.24; p = 0.811) and HR = 1.07 (95% CI 0.89 to 1.29; p = 0.492) respectively). Statin use was not associated with all-cause mortality (HR 1.05 (95% CI, 0.75 to 1.47, p = 0.777)). Conclusion We did not find any association between statin use and risk of AECOPD or all-cause mortality. The result adds to the evidence that an aggressive approach with statin treatment upfront is not beneficial in COPD, unless prescribed according to current guidelines for cardiovascular diseases.
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Affiliation(s)
- Mathias Damkjær
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Kjell Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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