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Graul EL, Nordon C, Rhodes K, Marshall J, Menon S, Kallis C, Ioannides AE, Whittaker HR, Peters NS, Quint JK. Temporal Risk of Nonfatal Cardiovascular Events After Chronic Obstructive Pulmonary Disease Exacerbation: A Population-based Study. Am J Respir Crit Care Med 2024; 209:960-972. [PMID: 38127850 DOI: 10.1164/rccm.202307-1122oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Rationale: Cardiovascular events after chronic obstructive pulmonary disease (COPD) exacerbations are recognized. Studies to date have been post hoc analyses of trials, did not differentiate exacerbation severity, included death in the cardiovascular outcome, or had insufficient power to explore individual outcomes temporally.Objectives: We explore temporal relationships between moderate and severe exacerbations and incident, nonfatal hospitalized cardiovascular events in a primary care-derived COPD cohort.Methods: We included people with COPD in England from 2014 to 2020, from the Clinical Practice Research Datalink Aurum primary care database. The index date was the date of first COPD exacerbation or, for those without exacerbations, date upon eligibility. We determined composite and individual cardiovascular events (acute coronary syndrome, arrhythmia, heart failure, ischemic stroke, and pulmonary hypertension) from linked hospital data. Adjusted Cox regression models were used to estimate average and time-stratified adjusted hazard ratios (aHRs).Measurements and Main Results: Among 213,466 patients, 146,448 (68.6%) had any exacerbation; 119,124 (55.8%) had moderate exacerbations, and 27,324 (12.8%) had severe exacerbations. A total of 40,773 cardiovascular events were recorded. There was an immediate period of cardiovascular relative rate after any exacerbation (1-14 d; aHR, 3.19 [95% confidence interval (CI), 2.71-3.76]), followed by progressively declining yet maintained effects, elevated after one year (aHR, 1.84 [95% CI, 1.78-1.91]). Hazard ratios were highest 1-14 days after severe exacerbations (aHR, 14.5 [95% CI, 12.2-17.3]) but highest 14-30 days after moderate exacerbations (aHR, 1.94 [95% CI, 1.63-2.31]). Cardiovascular outcomes with the greatest two-week effects after a severe exacerbation were arrhythmia (aHR, 12.7 [95% CI, 10.3-15.7]) and heart failure (aHR, 8.31 [95% CI, 6.79-10.2]).Conclusions: Cardiovascular events after moderate COPD exacerbations occur slightly later than after severe exacerbations; heightened relative rates remain beyond one year irrespective of severity. The period immediately after an exacerbation presents a critical opportunity for clinical intervention and treatment optimization to prevent future cardiovascular events.
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Affiliation(s)
| | | | | | | | - Shruti Menon
- Medical and Scientific Affairs, AstraZeneca, London, United Kingdom
| | - Constantinos Kallis
- School of Public Health and
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anne E Ioannides
- School of Public Health and
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hannah R Whittaker
- School of Public Health and
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jennifer K Quint
- School of Public Health and
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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New-Onset Atrial Fibrillation Is a Risk Factor of Ischemic Stroke in Chronic Obstructive Pulmonary Disease. Healthcare (Basel) 2022; 10:healthcare10020381. [PMID: 35206997 PMCID: PMC8871767 DOI: 10.3390/healthcare10020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) induces atrial fibrillation (AF) and stroke, and COPD with AF increased ischemic stroke (IS) in a cross-sectional study. Therefore, healthcare providers must be concerned and well-informed about this particular situation. For this study, inpatient data were obtained from the Taiwan National Health Insurance Database in 2010. We identified patients who were hospitalized with COPD (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] is 491, 492, and 496). Patients who experienced AF (ICD-9-CM to 427.3) during the same admission or after COPD hospitalization were discharged and defined as new-onset AF. The outcome was IS (ICD-9-CM as 433–437). The factors related to IS after COPD were used for multivariate logistic regression. There were 4177/62163 (6.72%) patients with incident IS. The risk of IS after COPD hospitalization was shown to have an adjusted odds ratio of 1.749 (95% CI: 1.584–1.93, p < 0.001) for patients with new-onset AF. Other factors included advanced age, atherosclerosis factors, comorbidity severity, sepsis and lower-level hospital admission. In conclusion, COPD patients suffering from new-onset AF had an increased incidence of IS in the population observation study. New-onset AF was an omit risk factor for IS in COPD in the Chinese population.
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Whittaker HR, Bloom C, Morgan A, Jarvis D, Kiddle SJ, Quint JK. Accelerated FEV 1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients. Eur Respir J 2021; 57:13993003.00918-2020. [PMID: 32972984 PMCID: PMC7930472 DOI: 10.1183/13993003.00918-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population. COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD)-GOLD primary care dataset (n=36 382). Accelerated decline in forced expiratory volume in 1 s (FEV1) was defined using the fastest quartile of the COPD population's decline. A Cox regression was used to assess the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease and CVD mortality). The model was adjusted for age, sex, smoking status, body mass index, history of asthma, hypertension, diabetes, statin use, Modified Medical Research Council (mMRC) dyspnoea score, exacerbation frequency and baseline FEV1 % predicted. 6110 COPD patients (16.8%) had a CVD event during follow-up; median length of follow-up was 3.6 years (interquartile range (IQR) 1.7–6.1 years). Median rate of FEV1 decline was –19.4 mL·year−1 (IQR –40.5–1.9); 9095 patients (25%) had accelerated FEV1 decline (> –40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98, 95% CI 0.90–1.06). Corresponding risk estimates were 0.99 (95% CI 0.83–1.20) for heart failure, 0.89 (95% CI 0.70–1.12) for myocardial infarction, 1.01 (95% CI 0.82–1.23) for stroke, 0.97 (95% CI 0.81–1.15) for atrial fibrillation, 1.02 (95% CI 0.87–1.19) for coronary artery disease and 0.94 (95% CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with a mMRC score ≤2 and two or more exacerbations in the year prior. CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea score but not with accelerated FEV1 decline. In a primary care population of COPD patients, CVD outcomes and mortality were not associated with accelerated FEV1 decline but with frequent and severe exacerbations of COPD and increased breathlessnesshttps://bit.ly/35APXL6
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Affiliation(s)
- Hannah R Whittaker
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Chloe Bloom
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Ann Morgan
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Deborah Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Steven J Kiddle
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.,Joint last authors
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.,Joint last authors
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Almagro P, Boixeda R, Diez-Manglano J, Gómez-Antúnez M, López-García F, Recio J. Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:755-764. [PMID: 32341642 PMCID: PMC7166051 DOI: 10.2147/copd.s238214] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/30/2020] [Indexed: 12/24/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in the context of a "cardiopulmonary continuum" rather than being simply attributed to shared risk factors, in particular, cigarette smoking. Both disease entities are centrally linked to systemic inflammation as well as aging, arterial stiffness, and several common biomarkers that led to the development of pulmonary hypertension, left ventricular diastolic dysfunction, atherosclerosis, and reduced physical activity and exercise capacity. For these reasons, COPD should be considered an independent factor of high cardiovascular risk, and efforts should be directed to early identification of cardiovascular disease (CVD) in COPD patients. Assessment of the overall cardiovascular risk is especially important in patients with severe exacerbation episodes, and the same therapeutic target levels for glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C), or blood pressure than those recommended by clinical practice guidelines for patients at high cardiovascular risk, should be achieved. In this review, we will discuss the most recent evidence of the role of COPD as a critical cardiovascular risk factor and try to find new insights and potential prevention strategies for this disease.
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Affiliation(s)
- Pere Almagro
- Multimorbidity Patient Unit, Service of Internal Medicine, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Ramon Boixeda
- Service of Internal Medicine, Hospital de Mataró-CSDM, Barcelona, Mataró, Spain
| | | | - María Gómez-Antúnez
- Service of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco López-García
- Service of Internal Medicine, Hospital General Universitario de Elche, Alicante, Elche, Spain
| | - Jesús Recio
- Service of Internal Medicine, Hospital Quironsalud València, Valencia, Spain
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Bolotova EV, Yavlyanskaya VV, Dudnikova AV. Predicting of the risk of major cardiovascular events developing in patients with chronic obstructive pulmonary disease in combination with renal dysfunction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-3-75-80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim.To identify the independent predictors of major cardiovascular events (MCVE) in patients with chronic obstructive pulmonary disease (COPD) in combination with the early stages of chronic kidney disease (CKD).Material and methods.The study included 279 patients with GOLD 2014 2-4 severity COPD. At the first stage, we surveyed the potential risk factors for MCVE and the level of 25-OH vitamin D. After 12 months, all patients had a history of MCVE. Patients were divided into 2 groups: those who had MCVE during the previous 12 months, and without them. The risk factors for the development of MCVE, significantly differing between the two groups according to the results of a univariate analysis, were included in the logistic regression to determine reliable independent predictors of MCVE. We also studied ROC curve to identify the prognostic cut-off point.Results.The group of patients who had MCVE consisted of 37 people with 40 MCVE cases. In patients with COPD in combination with the early stage of CKD, the level of vitamin D, the frequency of exacerbations in the preceding 12 months, the glomerular filtration rate (GFR), the score of PROCAM scale significantly influence to the development of MCVE. For the constructed regression equation, the determination coefficient is defined as R2=0,76, Hosmer-Lemeshov criterion =0,8. The area under the curve for the model =0,95. According to the results of the ROC analysis, it was found that independent predictors of MCVE in a 12-month period in patients with COPD and CKD (early stages) are: the sum of PROCAM scale points >56, the frequency of COPD exacerbations for the previous 12 months >2, GFR <80 ml/min/1,73 m2, the level of vitamin D <34,3 ng/ml.Conclusion.Independent predictors of MCVE in a 12-month period in patients with COPD and the early stages of CKD are: the score of the PROCAM scale >56, the frequency of exacerbations of COPD in the preceding 12 months >2, GFR <80 ml/min/1,73 m2, the level of vitamin D <34,3 ng/ml.
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John C, Reeve NF, Free RC, Williams AT, Ntalla I, Farmaki AE, Bethea J, Barton LM, Shrine N, Batini C, Packer R, Terry S, Hargadon B, Wang Q, Melbourne CA, Adams EL, Bee CE, Harrington K, Miola J, Brunskill NJ, Brightling CE, Barwell J, Wallace SE, Hsu R, Shepherd DJ, Hollox EJ, Wain LV, Tobin MD. Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED). Int J Epidemiol 2019; 48:678-679j. [PMID: 31062032 PMCID: PMC6659362 DOI: 10.1093/ije/dyz073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola F Reeve
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Robert C Free
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Ioanna Ntalla
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London Medical School, Queen Mary University of London, Charterhouse Square, London, UK
| | - Aliki-Eleni Farmaki
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Jane Bethea
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Linda M Barton
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chiara Batini
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Packer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Terry
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Beverley Hargadon
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Qingning Wang
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl A Melbourne
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma L Adams
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine E Bee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kyla Harrington
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - José Miola
- Leicester Law School, University of Leicester, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences University of Leicester, Leicester, UK
| | - Christopher E Brightling
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Julian Barwell
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Susan E Wallace
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ron Hsu
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David J Shepherd
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Edward J Hollox
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Bolotova EV, Yavlyanskaya VV, Dudnikova AV. [Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease]. KARDIOLOGIYA 2019; 59:52-60. [PMID: 30990153 DOI: 10.18087/cardio.2539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022]
Abstract
AIM To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD). MATERIALS AND METHODS The study included 172 elderly patients with stage 3-4 COPD associated with stage 1-2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point. RESULTS 21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack - in 23.8%, acute coronary syndrome - in 23.8%, and pulmonary thromboembolism (PTE) - in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823-0.925, р=0.001). A total PROCAM score <50 (95% CI, 0.882-0.964, р=0.001); GFR ≥80 ml/min/1.73 m2 (95% CI, 0.750-0.870, р=0.001); and a level of vitamin D ≥33 ng/ml (95% CI, 0.730-0.855, р=0.001) reduced the risk for MCVE. CONCLUSIONS In elderly patients with grade 3-4 COPD associated with stage 1-2 CKD, the development of MCVE within 12 months was determined by the incidence of COPD exacerbations for the previous 12 months >3 while a total PROCAM score <50, GFR >80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients.
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Affiliation(s)
- E V Bolotova
- Kuban State Medical University, Sedina st. 4, Krasnodar, Russia 350063
| | - V V Yavlyanskaya
- Kuban State Medical University, Sedina st. 4, Krasnodar, Russia 350063
| | - A V Dudnikova
- State Budgetary Institution of Health Care, Territorial Clinical Hospital #2, Krasnykh Partizan 6, k. 2, Krasnodar, Russia 350012
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