COPD exacerbations may heighten long-term cardiovascular risks

The study involving 142,787 COPD patients published in the BMJ journal Heart revealed a significant increase in risks of C events following disease exacerbations. The researchers reported a 16-fold rise in the risk for major CV events (adjusted HR 15.86) in the week post-exacerbation compared to non-exacerbation periods.

Also, there was an increase in the risk of hospitalisation for all CV events of interest (acute coronary syndrome, heart failure, arrhythmia or cerebral ischaemia).

Exacerbations of chronic obstructive pulmonary disease are episodes of worsening of symptoms, leading to substantial mortality and morbidity. They are associated with increased systemic and airway inflammation and physiological changes, especially the hyperinflation development.

The retrospective cohort study was conducted by Nathaniel M Hawkins, The University of British Columbia, Vancouver, British Columbia, Canada, and colleagues to examine the risk of adverse cardiovascular events following an exacerbation of chronic obstructive pulmonary disease.

For this purpose, the researchers identified patients with COPD using administrative data from Alberta, Canada from 2014 to 2019. Exposure periods were 12 months following moderate or severe exacerbations. The reference period was the time preceding the first exacerbation.

The primary outcome of the study was the composite of all-cause death or first hospitalisation for HF, acute coronary syndrome, arrhythmia or cerebral ischaemia. Covariate-adjusted risks associated with six exposure subperiods following exacerbation were estimated using time-dependent Cox regression models.

The study revealed the following findings:

• Among 1 42 787 patients (mean age 68.1 years and 51.7% men), 43.4% experienced at least one exacerbation, and 23.9% died during a median follow-up of 64 months.
• The primary outcome occurred in 30.5% of patients with an incidence rate before exacerbation of 5.43 per 100 person-years. This increased to 95.61 per 100 person-years in the 1-7 days post exacerbation (adjusted HR 15.86) and remained increased for up to 1 year.
• The risk of both the composite and individual CV events was increased following either a moderate or a severe exacerbation, though greater and more prolonged following severe exacerbation.
• There was the highest magnitude of increased risk for HF decompensation (1-7 days, HR 72.34).

"Our findings revealed that moderate and severe COPD exacerbations are independent risk factors for adverse CV events, particularly HF decompensation," the researchers wrote.

"There is a need to evaluate the impact of optimising COPD management on CV outcomes," they added.

Reference:

Hawkins NM, Nordon C, Rhodes K, Talukdar M, McMullen S, Ekwaru P, Pham T, Randhawa AK, Sin DD. Heightened long-term cardiovascular risks after exacerbation of chronic obstructive pulmonary disease. Heart. 2024 Jan 5:heartjnl-2023-323487. doi: 10.1136/heartjnl-2023-323487. Epub ahead of print. PMID: 38182279.