Pulmonary hospitalizations and ischemic heart disease events in patients with peripheral artery disease

Abstract

The prognostic significance of acute pulmonary events in people with lower extremity peripheral artery disease (PAD) is unknown. We hypothesized that an acute pulmonary event (hospitalization for pneumonia and/or chronic lower respiratory disease (CLRD) exacerbation) would be associated with a higher rate of subsequent ischemic heart disease (IHD) events in PAD. A total of 569 PAD participants were systematically identified from among patients in Chicago medical practices and followed longitudinally. Hospitalizations after enrollment were evaluated and adjudicated for pulmonary events. The primary outcome was adjudicated myocardial infarctions, unstable angina, and IHD death. Of 569 PAD participants, 34 (6.0%) were hospitalized for a pulmonary event (11 CLRD exacerbation and 23 pneumonia) during a mean follow-up of 1.52 years±0.80. Participants hospitalized for a pulmonary event had a higher rate of subsequent IHD events than those not hospitalized for a pulmonary event (10/34 (29%) vs 38/535 (7.1%), p<0.001). After adjusting for age, sex, race, comorbidities, and other confounders, a pulmonary hospitalization was associated with an increased risk of a subsequent IHD event (hazard ratio (HR) = 12.42, 95% confidence interval (CI) = 5.35 to 28.86, p<0.001). Non-pulmonary hospitalizations were also associated with IHD events (HR = 3.39, 95% CI = 1.78 to 6.44, p<0.001), but this association was less strong compared to pulmonary hospitalizations and IHD events (p = 0.011 for difference in the strength of association). In conclusion, hospitalization for an acute pulmonary event was associated with higher risk for subsequent IHD events in PAD. Future study should examine whether hospitalization for pulmonary events warrants increased surveillance or potential intervention to prevent IHD events in PAD.

Association of Chronic Obstructive Pulmonary Disease with Morbidity and Mortality in Patients with Peripheral Artery Disease: Insights from the EUCLID Trial

“…Patients with PAD who were hospitalized for acute pulmonary events have been shown to be at increased risk of MACE following the hospitalization, and the same has been observed in patients both with and without COPD. [13][14][15][16] This is hypothesized to be due to the inflammatory state associated with pulmonary hospitalizations. 13,15,16 It is possible that the increased risk of MI we observed in EUCLID participants with PAD and COPD is attributable to the more frequent respiratory-related adverse events experienced by the patients with PAD and baseline COPD.…”

Association between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease in Construction Workers-A Cross-Sectional Study

“…[22] In contrast, ischemic heart disease and PAD are mainly caused by atherosclerotic changes in the coronary arteries and lower limb arteries, respectively, which represent large arteries (i.e., macroangiopathy). [23] Future research is required to elucidate the pathogenic mechanisms linking COPD and vascular diseases, as well as the relative contributions of airway disease versus emphysema in macro-and microangiopathies.…”

Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

“…Along these lines, longitudinal examinations exploring the relationship among COPD and occurrence PAD are required. [9] likewise, in spite of the fact that PAD is known to fundamentally affect mortality, it is obscure whether the danger of mortality is higher in patients with both COPD and PAD. [10] The lower leg brachial record test is a speedy, non-obtrusive approach to check for fringe course illness (PAD).…”