Chronic obstructive pulmonary disease severity and cardiovascular outcomes

Curkendall, Suellen M.; Lanes, Stephan; Luise, Cynthia de; Stang, Mary Rose; Jones, Judith K.; She, Dewei; Goehring, Earl L.

doi:10.1007/s10654-006-9066-1

Cited by 96 publications

(82 citation statements)

References 24 publications

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“…There was also an increased risk of hospitalization secondary to cardiovascular causes in the COPD group [6].…”

Section: Introductionmentioning

confidence: 94%

The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

Shah¹,

Desai²

2017

Chron Obstruct Pulmon Dis

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COPD is one of the leading causes of Mortality & Morbidity in the US and is associated with a wide variety of cardiovascular diseases especially arrhythmias, angina, myocardial infarction and congestive heart failure and is directly associated with the severity of COPD described in the GOLD initiative. COPD is an independent risk factor for AF/AFL. Smoking, hypoxia and inflammation all contribute to AF in COPD patients mainly via atrial remodeling while hypercapnia contributes to it via increasing refractoriness of the atrial musculature and a delay in the return of the refractoriness to normal after resolution of the hypercapnia. The most common EKG abnormality found in patients with COPD is P pulmonale and the PQ interval is the strongest predictor of developing AF. The P wave Dispersion (PwD) was also an independent risk factor for the development of AF and was found to be more in the acute phase than in the stable phase.The BODE index, an important prognostic score among patients hospitalized with a COPD exacerbation has a direct co relation with the prevalence of AF/AFL while the DECAF score, which was found to be superior to the CURB 65 score as a mortality predictor for hospitalized patients, includes AF as one of the criteria. Chronic hypoxemia is one of the main reasons for altered pulmonary vein anatomy and hence the presence of COPD was identified as an independent risk factor for the recurrence of atrial tachyarrhythmias after catheter ablation in patients with COPD and the absence of COPD was also found to be an independent predictor for a successful electrocardioversion. These patients were also found to have an increased incidence of non-PV foci for the arrhythmias. Oral glucocorticoids were associated with an increased risk of developing AF especially high dose steroids. It is recommended to correct the underlying respiratory decompensation while treating patients with AF as they render the treatment of AF ineffective. Nondihydropyridine calcium channel blockers should be used as first line rate control agents for AF in patients with concomitant COPD while the β-blockers, sotalol, propafenone can be used in patients with obstructive lung disease who do not have bronchospasm.

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“…There was also an increased risk of hospitalization secondary to cardiovascular causes in the COPD group [6].…”

Section: Introductionmentioning

confidence: 94%

The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

Shah¹,

Desai²

2017

Chron Obstruct Pulmon Dis

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“…These patients with more severe COPD are almost twice as likely to die of cardiovascular causes than those with less severe disease. 34 Four independent clinical variables for concomitant heart failure in COPD can be measured in the primary care setting: history of ischaemic heart disease, high body mass index (BMI), laterally displaced …”

Section: Cardiovascular Diseasementioning

confidence: 99%

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Molena

2010

Primary Care Respiratory Journal

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Introduction: In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality.

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“…Similar results were observed for arterial hypertension and diabetes mellitus. The high 1-year exacerbation rates in our study could be also explained by the fact that previous exacerbations are predictors of future exacerbations [10].The association of respiratory diseases with CVD, arterial hypertension and diabetes mellitus has been previously described [11,12]. To our knowledge, this is the first study that evaluates the impact of these comorbidities in addition to the GOLD 2011/2013 classifications.…”

mentioning

confidence: 56%

Cardiovascular comorbidities in hospitalised COPD patients: a determinant of future risk?

et al. 2015

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Cardiovascular disease (CVD), diabetes mellitus and arterial hypertension increase the risk of death and hospitalisations of chronic obstructive pulmonary disease (COPD) patients [1]. COPD patients with CVD are at increased risk of COPD-related hospitalisations [2]. Arterial hypertension is one of the most prevalent comorbidities, influencing 40-60% of COPD patients [1]. Diabetes mellitus is more prevalent in moderate to very severe COPD than in the general population [1] and hyperglycaemia during acute exacerbations of COPD (AECOPD) is associated with increased in-hospital mortality [3]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a multidimensional classification for COPD management [4,5] that includes symptoms and future risk of AECOPD, based on the severity of airflow limitation and previous exacerbation history. A recent study has shown that the risk of future hospital admission due to COPD and cardiovascular death is higher in the more symptomatic group B compared with group C, regardless the functional advantage of patients in the first group [6]. Our study assessed the effect of CVD, arterial hypertension and diabetes mellitus on the time to first AECOPD, and on exacerbation and hospitalisation risk in groups A-D of the GOLD 2011 and 2013 classification, in a cohort of patients admitted to hospital for AECOPD.We prospectively enrolled 609 consecutive patients admitted to respiratory medicine departments of two tertiary hospitals with a diagnosis of AECOPD between March 2009 and February 2013. All subjects were current or ex-smokers with ⩾20 pack-years and a previous spirometry-confirmed diagnosis of COPD. Patients with other comorbid respiratory conditions, comorbidities that might result in a limited expected survival (such as malignancies, leukaemia or AIDS) or with an inability to cooperate with the investigators were excluded. The study protocol was approved by the ethics committees of both hospitals and participants provided informed consent. Symptoms were evaluated according to the COPD assessment test (CAT) [7] and the modified Medical Research Council (mMRC) dyspnoea scale [8]. Spirometry data were from patients' medical records when their COPD was stable (during the last 6 months and ⩾4 weeks before admission). Patients were categorised into the GOLD 2011 groups, as follows. Group A: fewer symptoms (mMRC <2/CAT <10), forced expiratory volume in 1 s (FEV1) >50% predicted and fewer than two exacerbations in the previous year. Group B: more symptoms (mMRC ⩾2/CAT ⩾10), FEV1 >50% predicted and fewer than two exacerbations in the previous year. Group C: fewer symptoms (mMRC <2/ CAT <10), FEV1 ⩽50% predicted and/or two or more exacerbations in the previous year. Group D: more symptoms (mMRC ⩾2/CAT ⩾10), FEV1 ⩽50% predicted and/or two or more exacerbations in the previous year [4]. In cases of discrepancy between the CAT and mMRC scales, the patient was categorised in the higher category (B or D). We performed an additional analysis classifying all our hospitalised pat...

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Chronic obstructive pulmonary disease severity and cardiovascular outcomes

Abstract: Patients with more severe COPD, as defined by our model, had higher cardiovascular morbidity and mortality than patients with less severe COPD.

Cited by 96 publications

References 24 publications

The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

Cardiovascular comorbidities in hospitalised COPD patients: a determinant of future risk?

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