Acute exacerbations of COPD associated with risk for acute cardiovascular event

The results highlight how an acute exacerbation of chronic obstructive pulmonary disease (COPD) may be an opportunity to implement cardiovascular prevention measures in high-risk patients, the authors said.

Patients who experience an acute exacerbation of chronic obstructive pulmonary disease (COPD) may be at increased risk for a subsequent cardiovascular event, according to a new study.

Researchers performed a case-series analysis of data from patients in three U.S. states from 2005 through 2011 who were at least 40 years of age and had an acute COPD exacerbation. The goal of the study was to determine whether an acute exacerbation was associated with acute cardiovascular event incidence at 30 days and one year. The primary outcome measure was a composite of an ED visit or nonelective hospitalization for an acute cardiovascular event (acute myocardial infarction, heart failure, atrial fibrillation, pulmonary embolism, and stroke). Incidence rate ratios (IRRs) were estimated for acute cardiovascular event incidence in the 30-day period before the index exacerbation and the 30 days afterward, as well as for the one-year period after the index exacerbation versus the one-year period before it. Study results were published online June 8 by the Journal of General Internal Medicine.

The study included 362,867 patients who had an ED visit or hospitalization for an acute COPD exacerbation. Median age was 70 years, 57% of patients were women, and 71% were of non-Hispanic white ethnicity. The incidence of acute cardiovascular events was significantly higher in the 30 days postexacerbation versus the 30-day reference period (IRR, 1.34; P<0.001) and in the year postexacerbation versus the one-year reference period (IRR, 1.20; P<0.001). This association between an acute COPD exacerbation and an acute cardiovascular event persisted for each cardiovascular condition separately (P<0.05 for all).

The researchers noted that administrative data could have misclassified some hospitalizations and that the databases used did not include information on clinical variables such as chronic COPD severity, among other limitations. However, they concluded that an association exists between acute COPD exacerbation and increased incidence of a subsequent acute cardiovascular event at 30 days and one year.

“Our findings should encourage researchers to elucidate the mechanisms linking [acute exacerbation of COPD] to the development of cardiovascular events,” the authors wrote. “For clinicians, our data support an importance of [acute exacerbation of COPD] as an opportunity to implement cardiovascular prevention measures in this high-risk population.”