Frequent COPD Exacerbations Linked to Increased Risk of Heart Attack and Pulmonary Embolism: Study

Acute exacerbations of COPD are established inciting factors for further worsening of respiratory function; however, increasing evidence suggests that these events are also related to heightened cardiovascular risk. Cardiovascular disease (CVD) and pulmonary embolism (PE) present significant complications in COPD patients, and the need to clarify the relationship between frequency of exacerbation and cardiovascular outcomes is posed.This study examined whether increasing numbers and greater severity of exacerbations were associated with a long-term increased risk of myocardial infarction (MI) and PE.

This study used data from the Swedish National Airway Register and included 66,422 patients aged 30 years or older with a main COPD diagnosis from January 2014 through June 2022. Only patients with complete data on lung function at baseline were included in the cohort. AECOPDs before the index date were classified as moderate, requiring oral corticosteroids, or severe, requiring hospitalization, based on the year before the index date. Patients were followed up until December 2022, with more than 265 000 patient-years of data and a maximum follow-up of nine years.

The primary outcome variables of interest were hospitalized or fatal MI and PE. We calculated subdistribution hazard ratios with 95% confidence intervals using competing-risk regression adjusted for confounders.

Key Findings

• The study found a clear and gradual increase in the risk of MI and PE with both the number and severity of exacerbations.

Compared to patients with no exacerbations in the baseline period:

• Patients with one moderate exacerbation had a 10% increased risk of MI (SHR 1.10, 95% CI: 0.97-1.24) and a 33% increased risk of PE (SHR 1.33, 95% CI: 1.11-1.60).

• In patients with two or more severe exacerbations, the risks increased to 82% for MI with an SHR of 1.82, 95% CI: 1.36–2.44, and to 162% for PE with an SHR of 2.62.

• Sensitivity analysis showed that risk was highest in the first year following an exacerbation, with a subsequent decrease in associated strength over time. Therefore, it would seem that recent exacerbations have a more immediate impact on cardiovascular events.

• Given the large sample size and long-term follow-up in a real-world setting, increased reliability means its conclusions like shifting to a greater importance of monitoring frequency of exacerbations in clinical practice can be applied.

These findings accentuate how important exacerbation management is in the care of patients with COPD for respiratory health and prevention of serious cardiovascular events, such as MI and PE. A graded increase in risk with exacerbation severity and frequency suggests that patients who have experienced multiple severe exacerbations are at especially high risk and might benefit from targeted cardiovascular prevention strategies.

This large cohort study demonstrates that in patients with COPD, frequent and severe AECOPDs are correlated with a significantly increased risk for MI and PE. These findings call for comprehensive management strategies oriented toward both pulmonary and cardiovascular health in this vulnerable population.

Reference:

Wallström, O., Stridsman, C., Lindberg, A., Nyberg, F., & Vanfleteren, L. E. G. W. (2024). Exacerbation history and risk of myocardial infarction and pulmonary embolism in chronic obstructive pulmonary disease. Chest. https://doi.org/10.1016/j.chest.2024.07.150