Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Chen, Wenjia; Thomas, Jamie M.; Sadatsafavi, Mohsen

doi:10.1016/s2213-2600(15)00241-6

Cited by 487 publications

(421 citation statements)

References 55 publications

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“…We added hypertension, dyslipidemia, and BMI, because these cardiovascular risk factors and the metabolic syndrome are more prevalent in both patients with cryptogenic axonal polyneuropathy and patients with COPD compared to controls. [1][2][3][4]11 Smoking is one of the most important risk factors for COPD, but there is no evidence of an independent association with polyneuropathy. 16 Therefore, smoking was not considered a possible confounder.…”

Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease is not a risk factor for polyneuropathy: A prospective controlled study

et al. 2016

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Polyneuropathy has been observed in patients with chronic obstructive pulmonary disease (COPD). If polyneuropathy occurs as a complication or extrapulmonary manifestation of COPD, one would expect an increased prevalence among patients with a cryptogenic axonal polyneuropathy. This case-control study aimed to investigate the association between COPD and polyneuropathy. We prospectively included 345 patients with cryptogenic axonal polyneuropathy and 465 controls. A standardized questionnaire assessed the presence of COPD and we verified this diagnosis by contacting the family physician. The severity of COPD was based on the Global Initiative for Chronic Obstructive Lung Disease classification. The prevalence of COPD did not differ between patients with polyneuropathy and controls (15/345 vs. 12/465 respectively; odds ratio (OR) 1.7; 95% confidence interval (CI) [0.8-3.7]). Adjusting for age, gender and possible confounders did not affect these results (adjusted OR 1.7, 95% CI 0.7-4.1). The severity of COPD was similar between patients with polyneuropathy and controls. This study does not support the hypothesis that COPD is a risk factor for polyneuropathy.

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Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease is not a risk factor for polyneuropathy: A prospective controlled study

et al. 2016

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“…The possibility that some patients with COPD harbored subclinical features of CVD, such as coronary artery disease or pulmonary hypertension, cannot be ruled out. Indeed, a recent meta-analysis has shown compelling evidence that COPD is associated with increased risk of common cardiovascular risk factors including smoking, diabetes and hypertension [41]. Patients with coexistent CVD or impaired oxygen-carrying capacity may exhibit impaired respiratory muscle oxygenation [8], therefore since the ability of these muscles to function anaerobically is limited [42], their ability to sustain spontaneous ventilation is ultimately limited by their aerobic capacity.…”

Section: Limitations Of Studymentioning

confidence: 99%

Breathing Intolerance Index (BIT) and its Relation to Exercise Data: Noninvasive Assessment of Inspiratory Muscle Endurance during Rest and Exercise in Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Disorders

Baydur¹,

Tran²,

Pallickal³

et al. 2016

Chron Obstruct Pulmon Dis

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Rationale: Diaphragmatic tension-time index [TTdi = (Pdi/Pdimax)(Ti/ Ttot)] assesses inspiratory muscle endurance during rest and exercise. However, the procedure is invasive and not practical for general use. Recently, Tidal Volume/Vital Capacity (Vt/VC) has been substituted for Pdi/Pdimax, to assess need for assisted ventilation in chronic respiratory disorders. This technique has not been used to assess respiratory muscle endurance in other conditions during rest and exercise.Objective: To compare control of ventilation and BIT in cardiorespiratory disorders and controls and to assess their relation to oxygen uptake (V'O 2 ) and annual acute decompensations.Methods: BIT and V'O 2 were assessed in patients with stable CVD (n = 20), RD (n = 20) and C (n = 20) during bicycle ergometry. ANOVA assessed differences in variables amongst cohorts at rest and peak exercise. Results:Resting BIT was [median (25 th , 75 th percentiles)] 0.06 (0.04, 0.07), 0.06 (0.04, 0.09) and 0.04 (0.03, 0.05) for CVD, COPD and controls, respectively. Compared to resting, BIT increased by 3.0-to 4.6-fold at peak exercise in all cohorts (p < 0.0001). V'O 2 max exceeded resting values by 7.5-, 4.6-, and 9.4-fold in COPD, CVD and C, respectively (all p < 0.0001). When corrected for BIT (V'O 2 /BIT), controls exhibited significantly greater (V'O 2 /BIT) max than CVD and COPD (p < 0.0001). Amongst patients who acutely decompensated, BIT was higher only in resting CVD patients (p < 0.019). Conclusions:BIT is useful for evaluating respiratory muscle effort during rest and exercise in CVD and COPD. Oxygen uptake fails to increase in proportion to BIT in these conditions as much as in controls, reflecting impaired oxygen utilization. Its potential usefulness in predicting acute decompensations should be assessed in larger prospective studies.

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“…Observational studies have shown that COPD is associated with a 2-5 times higher risk of ischaemic heart disease (IHD), cardiac dysrhythmia, heart failure, diseases of the pulmonary circulation, and diseases of the arteries, compared with non-COPD populations (4,5). A prospective evaluation of COPD exacerbations in patients with comorbid IHD from the London COPD Cohort reported longer duration but not an increased frequency of AECOPD in patients with IHD (6).…”

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confidence: 99%

Cardiovascular Disease Does Not Predict Exacerbation Rate or Mortality in Chronic Obstructive Pulmonary Disease

Jones

Müllerová

Agustí

et al. 2018

Am J Respir Crit Care Med

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Cardiovascular disease (CVD) is common in patients with chronic obstructive pulmonary disease (COPD) (1-4), yet it is unclear whether its presence increases the incidence of acute exacerbations (AECOPD) or the risk of death. Observational studies have shown that COPD is associated with a 2-5 times higher risk of ischaemic heart disease (IHD), cardiac dysrhythmia, heart failure, diseases of the pulmonary circulation, and diseases of the arteries, compared with non-COPD populations (4,5). A prospective evaluation of COPD exacerbations in patients with comorbid IHD from the London COPD Cohort reported longer duration but not an increased frequency of AECOPD in patients with IHD (6).This prospective study was designed to test the hypothesis that the presence of CVD increases the risk of AECOPD and/or death in COPD patients recruited in a primary care setting. MethodsThe ACCESS study (Assessment of Comorbidities in COPD in European Symptomatic Subjects; NCT01516528; 115058 study) was a prospective, longitudinal, observational, non-drug interventional, two-year study in COPD patients enrolled from primary care in Belgium, France, Germany, the Netherlands, Poland, and Spain. Patients, visiting their general practitioner (GP) for any reason, were invited to participate if they were ≥40 years old, current or ex-smoker (smoking history of ≥10 pack-years), a minimum of 12 months of prior history of COPD, and a forced expiratory volume in one second (FEV 1 )/forced vital capacity (FVC) postbronchodilator ratio <0.70. Patients with a primary diagnosis of asthma, pulmonary fibrosis, asbestosis, any cancer or clinically significant bronchiectasis were excluded. Page 3 of 12 3Patients were followed up for 27 months through clinic visits at screening (-3 months), baseline (0 months), 12 months and 24 months, and by phone at 3, 6, 9, 15, 18 and 21 months. Written informed consent was obtained from all subjects and the study was approved by independent ethics committees as per the requirements in each country.The prevalence of CVD at baseline was defined using a composite measure with previously published criteria (7). The primary outcome was the annual rate of moderate-severe AECOPD during the 24-month follow-up period. Moderate AECOPD was defined as a worsening of symptoms that required oral corticosteroids and/or antibiotics, whilst severe exacerbations were defined as those that included hospitalization. Mortality was a secondary outcome; details of patient deaths were obtained from the GP.To derive event rates and test associations, we applied multivariable negative binomial regression and Cox proportional hazards regression models, respectively.All analysis was pre-specified except hospitalizations and mortality outcome modeling which were post-hoc. Results2,887 evaluable patients were included in this analysis. Their mean age was 66 years, 70% were male, and 47% were current smokers with a mean postbronchodilator FEV 1 % predicted of approximately 60% (Table 1). The mean number of moderate-severe AECOPD episodes in the prev...

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Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Cited by 487 publications

References 55 publications

Chronic obstructive pulmonary disease is not a risk factor for polyneuropathy: A prospective controlled study

Chronic obstructive pulmonary disease is not a risk factor for polyneuropathy: A prospective controlled study

Breathing Intolerance Index (BIT) and its Relation to Exercise Data: Noninvasive Assessment of Inspiratory Muscle Endurance during Rest and Exercise in Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Disorders

Cardiovascular Disease Does Not Predict Exacerbation Rate or Mortality in Chronic Obstructive Pulmonary Disease

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