Frequent and Severe COPD Exacerbations Linked to Higher Risks of Myocardial Infarction and Pulmonary Embolism: Study

The study, published in the CHEST journal, revealed that acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) substantially increase the risk of MI and PE. The risk increases with both the frequency and severity of these exacerbations.

"Patients who experience two or more severe AECOPDs face nearly 1.8 times the risk of MI and more than 2.6 times the risk of PE compared to those without exacerbations. These heightened risks are particularly significant within the first year of follow-up," the researchers reported.

Chronic obstructive pulmonary disease is characterized by persistent respiratory symptoms and airflow limitation, often exacerbated by factors such as infections, environmental pollutants, and other triggers. These exacerbations can significantly impact a patient's health, leading not only to worsening pulmonary function but also to a heightened risk of severe complications. It is unclear whether a history of exacerbations is differently linked to the future risk of MI or PE.

To fill this knowledge gap, Oskar Wallström, University of Gothenburg, Gothenburg, Sweden, and colleagues determined if the number and severity of AECOPDs are associated with increased risk of MI or PE in a real-life cohort of patients with COPD.

For this purpose, they analyzed a cohort of 66,422 patients aged 30 and older with a primary diagnosis of chronic obstructive pulmonary disease (COPD) from the Swedish National Airway Register, covering the period from January 2014 to June 2022. All patients had complete lung function data. They were categorized based on exacerbation severity: moderate exacerbations were defined by the prescription of oral corticosteroids, while severe exacerbations were marked by hospitalization in the year leading up to the index date.

The cohort was monitored until December 2022 for occurrences of hospitalization or death due to myocardial infarction (MI) or pulmonary embolism (PE), resulting in over 265,000 patient-years of follow-up and a maximum follow-up period of 9 years. To assess the risk, we utilized competing-risk regression models based on Fine-Gray to calculate subdistribution hazard ratios (SHRs).

The study led to the following findings:

• Compared with no AECOPDs in the baseline period, AECOPD number and severity were associated with increased long-term risk of both MI and PE in a gradual fashion, ranging from an SHR of 1.10 and 1.33, respectively, for one moderate exacerbation, to 1.82 and 2.62, for two or more severe exacerbations.
• In a time-restricted follow-up sensitivity analysis, the associations were stronger during the first year of follow-up and diminished over time.

"The risk of myocardial infarction and pulmonary embolism increases with the frequency and severity of AECOPD in this large real-life cohort of patients with COPD," the researchers conclude.

Reference:

Wallström O, Stridsman C, Lindberg A, Nyberg F, Vanfleteren LEGW. Exacerbation history and risk of myocardial infarction and pulmonary embolism in chronic obstructive pulmonary disease. Chest. 2024 Jul 31:S0012-3692(24)04880-3. doi: 10.1016/j.chest.2024.07.150. Epub ahead of print. PMID: 39094732.