The untreated treatable trait: Cardiovascular disease in <scp>COPD</scp> exacerbations

Leong, Paul; Bardin, Philip G.

doi:10.1111/resp.14036

Cited by 3 publications

(4 citation statements)

References 19 publications

(26 reference statements)

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“…Comorbidities are common at any severity of COPD that may have a significant impact on disease process [ 1 ]. Among hospitalized population with an acute exacerbation of COPD (AECOPD) and severe airflow limitation, severe coronary artery disease (CAD) is present in about one-third of patients [ 2 ]. Moreover, patients with reduced lung function are at higher risk of developing CAD [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

et al. 2022

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Background Coronary artery disease (CAD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). However, data related to the impact of CAD on outcomes of acute exacerbation of COPD (AECOPD) are limited and whether the relationship depends on sex remains unknown. Our aim was to determine the impact of comorbid CAD on clinical outcomes among men and women with AECOPD. Methods We used data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is a nationwide observational real-world study conducted between September 2017 and February 2020 at 163 centers in patients admitted with AECOPD as their primary diagnosis. Patients were stratified according to the presence or absence of CAD in men and women. The primary outcomes were the length of hospital stay and economic burden during hospitalization. Results Among 3906 patients included in our study, the prevalence of CAD was 17.0%, and it was higher in women than in men (19.5% vs. 16.3%; P = 0.034). Age and other cardiovascular diseases were common factors associated with comorbid CAD in men and women, while body-mass index, cerebrovascular disease, and diabetes were determinants in men and pre-admission use of long-acting beta-adrenoceptor agonist and home oxygen therapy were protective factors in women. Only in men, patients with CAD had a longer length of hospital stay (median 10.0 vs. 9.0 days, P < 0.001), higher total cost during hospitalization (median $1502.2 vs. $1373.4, P < 0.001), and more severe COPD symptoms at day 30 compared to those without CAD. No significant difference was found in women. Comorbid CAD showed no relationship with 30-day readmission or death regardless of sex. In our real-world study, mortality/readmission risk within 30 days increased in patients with previous frequent hospitalizations and poorer pulmonary function. Conclusions In hospitalized AECOPD patients, comorbid CAD was significantly associated with poorer short-term outcomes in men. Clinicians should have heightened attention for men with comorbid CAD to achieve an optimal management of AECOPD patients.

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Section: Introductionmentioning

confidence: 99%

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

et al. 2022

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“…Cardiovascular diseases are among the most prevalent comorbidities of chronic obstructive pulmonary disease (COPD) 1 2 and asthma. 3 Cardiovascular medications are used not only to treat hypertension, arrhythmia, ischemic heart disease, and other cardiovascular diseases, but also to reduce the morbidity and mortality of heart failure and acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Medication Use and Risk of Acute Exacerbation in Patients With Asthma-COPD Overlap (CVACO Study)

Chang

et al. 2022

Allergy Asthma Immunol Res

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Purpose Current clinical guidelines are unclear regarding the association of cardiovascular medication with the risk of acute exacerbation (AE) in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Methods We conducted a retrospective cohort study by interrogating the claims database of Taipei Veterans General Hospital. Patients with coexistent fixed airflow limitation and asthma were enrolled as an ACO cohort between 2009 and 2017. Exposure to cardiovascular medications, including angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), non-selective beta-blockers, cardioselective beta-blockers, dihydropyridine (DHP) calcium channel blockers (CCBs), and non-DHP CCBs, in 3-month period each served as time-dependent covariates. Patients receiving a cardiovascular medication ≥ 28 cumulative daily doses were defined as respective cardiovascular medication users. Patients were followed up until December 31, 2018. The primary endpoint was severe AE, defined as hospitalization or emergency department visit for either asthma, COPD, or respiratory failure. The secondary outcome was moderate AE. Results The final study cohort consisted of 582 ACO subjects, with a mean follow-up period of 2.98 years. After adjustment, ARB (hazard ratio [HR], 0.64, 95% confidence interval [CI], 0.44–0.93, P = 0.019), cardioselective beta-blocker (HR, 0.29, 95% CI, 0.11–0.72, P = 0.008) and DHP CCB (HR, 0.66, 95% CI, 0.45–0.97, P = 0.035) therapies were associated with lower risks of severe AE. ARB (HR, 0.42, 95% CI, 0.30–0.62, P < 0.001) and DHP CCB (HR, 0.55, 95% CI, 0.38–0.80, P = 0.002) therapies were associated with lower risks of moderate AE. Cardioselective beta-blockers, ARBs, and DHP CCBs were associated with lower risks of severe AE in frequent exacerbators. ACEI, non-selective beta-blocker, or non-DHP CCB use did not change the risk of severe AE. Conclusions ARB, cardioselective beta-blocker, and DHP CCB therapies may lower the risk of AE in patients with ACO.

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“…One may consider and rule out alternative diagnoses that may be a cause for their dyspnea such as asthma and cardiovascular disease. [9][10][11][12][13][14][15][16][17] Other considerations may include inducible laryngeal obstruction or dysfunctional breathing disorder, [18][19][20][21] but ultimately, they are unable to explain to their patients what the cause of their shortness of breath is, even though their presumption is that they likely have "early Pre-COPD." 1,2 Hence, there remains a keen interest in furthering our understanding of the underlying pathophysiological mechanisms for the not uncommon report of exertional dyspnea in smokers or former smokers with symptoms disproportionate to their lung function.…”

Section: Introductionmentioning

confidence: 99%

“…microvascular dysfunction. 12,14,17,[22][23][24][25][26] Other studies have examined the ventilatory efficiency--(minute ventilation [VE] to carbon dioxide production [VCO2]) VE/VCO2 nadir: the lowest ventilatory rate able to remove 1 liter of CO2 per minute during graded cardiopulmonary exercise testing (CPET). [27][28][29][30][31] While many clinicians are familiar with the concept of dynamic hyperinflation that can lead to breath stacking and dyspnea, fewer non-pulmonary physicians are familiar with the assessment of ventilatory efficiency.…”

Section: Introductionmentioning

confidence: 99%

Journal Club: Impaired Ventilatory Efficiency and Exercise Intolerance in Former/Current Smokers With Dyspnea Disproportionate to Their Lung Function: Pathophysiological Insights Gained Through Cardiopulmonary Exercise Testing

Balkissoon¹,

Mkorombindo²

2022

J COPD F

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The untreated treatable trait: Cardiovascular disease in COPD exacerbations

Cited by 3 publications

References 19 publications

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

Cardiovascular Medication Use and Risk of Acute Exacerbation in Patients With Asthma-COPD Overlap (CVACO Study)

Journal Club: Impaired Ventilatory Efficiency and Exercise Intolerance in Former/Current Smokers With Dyspnea Disproportionate to Their Lung Function: Pathophysiological Insights Gained Through Cardiopulmonary Exercise Testing

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