
Study: Italian Patients With COPD at High Risk of Severe Cardiovascular Events
Italian patients with chronic obstructive pulmonary disease (COPD) face a significantly increased risk of severe cardiovascular events.
Italian patients with
The researchers explained that patients with COPD often face comorbidities. More specifically, over 80% of patients with COPD have at least 1 comorbidity, including cardiovascular diseases (CVDs), depression, and diabetes. CVDs, like hypertension and heart failure (HF), are the most common comorbidities in those with COPD as their onset risk is doubled.
Patients with COPD also periodically experience
A previous study
To create their study population, they
Past evidence
The researchers included 216,864 patients from the ReS database with COPD in their study population, the majority of which (55.5%) were male and had a mean (standard deviation [SD]) age of 74 (12) years. Of the study population, 129,886 (59.7%) were newly diagnosed with COPD; they had a mean (SD) age of 73 (12) years. CV and metabolic comorbidities were the most frequent, especially hypertension (75.8%) and dyslipidemias (34.4%).
During a mean follow-up duration of 34.4 (20.6; range, 0.03-60.0) months, 69,620 (32.1%) patients experienced at least 1 exacerbation. Of these, 47,953 patients (69.0%) had at least 1 moderate exacerbation, and 32,569 (46.8%) had at least 1 severe exacerbation. Compared to those with at least 1 moderate exacerbation, the researchers noted that patients with at least 1 severe exacerbation had a higher prevalence of all comorbidities of interest.
Additionally, 46,214 (21.3%) patients experienced at least 1 severe acute CV event during follow-up; HF was the most prevalent (13.9%), followed by acute coronary syndrome (5.0%). More specifically, during follow-up, 37,631 (81.4%) of these patients experienced a severe CV event before a moderate or severe exacerbation. Conversely, the remaining patients experienced a CV event within 365 days of an exacerbation (n = 10,269 patients) or more than 365 days following an exacerbation (n = 4428).
The crude IR of a CV event 365 days post-exacerbation was 15.8 per 100 person-years (95% CI, 15.5-16.1). In terms of periods, the crude IR of a CV event was highest within the first 7 days post-exacerbation (252.1 per 100 person-years; 95% CI, 245.3-258.9) and lowest between 181 and 365 days post-exacerbation (5.6 per 100 person-years; 95% CI, 5.3-5.9). Similarly, estimated HRs for severe CV event risk were highest within 7 days post-exacerbation (HR, 34.3; 95% CI, 33.1-35.6), especially for heart failure (HR, 50.6; 95% CI, 48.6-52.7); estimated HRs remained elevated for 365 days (HR, 1.1; 95% CI, 1.02-1.13).
The researchers acknowledged their limitations. For example, they recognized the potential misclassification of severe acute CV events as severe exacerbations within the first 7 days after symptoms. Because of the similarity between cardiac and respiratory symptoms, this 1 to 7-day period is prone to potential misclassification; they noted that the estimated HRs should be interpreted with this in mind. Despite their limitations, the researchers expressed confidence in their findings.
“Our findings emphasize the importance of early interventions and treatment optimization among patients with COPD to reduce cardiopulmonary risk by preventing COPD exacerbations and, in turn, non-fatal and fatal severe acute CV events,” the authors concluded.
References
1. Calabria S, Ronconi G, Dondi L, et al. Cardiovascular events after exacerbations of chronic obstructive pulmonary disease: Results from the Exacerbations of COPD and their outcomes in cardiovascular diseases study in Italy. Eur J Intern Med. doi:10.1016/j.ejim.2024.04.021
2. Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the "stroke of the lungs"?. Int J Chron Obstruct Pulmon Dis. 2016;11:1579-1586. doi:10.2147/COPD.S106160
3. Calabria S, Dondi L, Ronconi G, et al. Acute lower respiratory infections: real-world evidence of antibiotic prescription pattern and costs from a large administrative Italian database. Fam Pract. 2022;39(4):669-677. doi:10.1093/fampra/cmac002
4. Crisan L, Wong N, Sin DD, Lee HM. Karma of cardiovascular disease risk factors for prevention and management of major cardiovascular events in the context of acute exacerbations of chronic obstructive pulmonary disease. Front Cardiovasc Med. 2019;6:79. doi:10.3389/fcvm.2019.00079
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