Chronic obstructive pulmonary disease and the risk of cardiovascular diseases

Abstract

Previous large epidemiological studies reporting on the association between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases mainly focussed on prevalent diseases rather than on the incidence of newly diagnosed cardiovascular outcomes. We used the UK-based General Practice Research Database (GPRD) to assess the prevalence and incidence of cardiovascular diseases in COPD patients aged 40-79 between 1995 and 2005, and we randomly matched COPD-free comparison patients to COPD patients. In nested-case control analyses, we compared the risks of developing an incident diagnosis of cardiac arrhythmias, venous thromboembolism, myocardial infarction, or stroke between patients with and without COPD, stratifying the analyses by COPD-severity, using COPD-treatment as proxy for disease severity. We identified 35,772 patients with COPD and the same number of COPD-free patients. Most cardiovascular diseases were more prevalent among COPD patients than among the comparison group of COPD-free patients. The relative risk estimates of developing an incident diagnosis of cardiac arrhythmia (OR 1.19, 95% CI 0.98-1.43), deep vein thrombosis (OR 1.35, 95% CI 0.97-1.89), pulmonary embolism (OR 2.51, 95% CI 1.62-3.87), myocardial infarction (OR 1.40, 95% CI 1.13-1.73), or stroke (OR 1.13, 95% CI 0.92-1.38), tended to be increased for patients with COPD as compared to COPD-free controls. The findings of this large observational study provide further evidence that patients with COPD are at increased risk for most cardiovascular diseases.

Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease

“…In other studies of lung function and stroke, [15,14,23,22] or COPD and stroke, [16,19] estimates were only reduced with around 10%…”

“…[16] The incidence of stroke subtypes in COPD has not previously been assessed, to our knowledge. Studies of lung function in the general population have, however, reported inverse relationships of FEV1 with incidence of IS [15,22,23] and SAH [9], respectively.…”

“…Blood pressure is the major risk factor for ICH and it is not previously known how ICH relates to lung function or COPD. Even though the relationship between hypertension and COPD is inconsistent in the literature, with some studies reporting positive associations [11,12] and other studies no or negative associations [27,16,28], it is still possible that hypertension could constitute one link between COPD and ICH.…”

“…Most studies reported a moderate (10-50%) risk increase. [16,10,17,18] However, results have been inconsistent. Feary et al [19] found an almost three-fold increase in stroke incidence, although this high effect was mainly observed in younger age groups, whereas other studies reported no significant association between COPD and stroke after adjustment for comorbidities.…”

“…Feary et al [19] found an almost three-fold increase in stroke incidence, although this high effect was mainly observed in younger age groups, whereas other studies reported no significant association between COPD and stroke after adjustment for comorbidities. [18,16] Furthermore, previous studies of stroke incidence and COPD made no distinction between stroke subtypes. Hence, it is unclear to what extent COPD is associated with increased risk of stroke, and it is not known how COPD effects the risk of IS, ICH and SAH, respectively.…”