Cardiovascular Adverse Event Risk Following a COPD Exacerbation

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

In the first 30 days following an exacerbation of chronic obstructive pulmonary disease (COPD), there is an increased risk of cardiovascular (CV) adverse events, according to research presented at the 2020 CHEST Annual Meeting, held virtually October 18 to 21. Researchers conducted a post hoc analysis of the phase 3, randomized, double-blind, 52-week IMPACT trial (ClinicalTrials.gov Identifier: NCT02164513) to evaluate the time-dependent risk of CV events after an exacerbation.

Cardiac arrhythmias, cardiac failure, central nervous system hemorrhages and cerebrovascular conditions, hypertension, and ischemic heart disease were considered CV adverse events of special interest. Researchers assessed the time to first CV adverse event of special interest or CV adverse event of special interest that resulted in hospitalization or death during a COPD exacerbation and also from 1 to 30 days, 31 to 90 days, and 91 to 365 days following an exacerbation using a time-dependent repeated measures Cox model.

The risk of a CV adverse event of special interest increased significantly during a moderate or severe COPD exacerbation event (hazard ratio [HR], 2.63; P <.001 and HR, 21.84; P <.001, respectively). Furthermore, the risk of a CV adverse event of special interest that resulted in hospitalization or death also increased during moderate or severe COPD exacerbation events (HR, 2.46 and HR, 41.29, respectively; both P <.001).

However, the risk of a CV adverse event of special interest did decrease over time after a moderate (1-30 days: HR, 1.63; P <.001; 31-90 days: HR, 0.90; P =.486; 91-365 days: HR, 0.95; P =.720) or severe COPD exacerbation (1-30 days, HR: 1.75; P =.055; 31-90 days: HR, 1.61, P =.091; 91-365 days: HR, 1.12; P =.725). Likewise, the risk of a CV adverse event of special interest that resulted in hospitalization or death also decreased over time after a moderate (1-30 days: HR, 2.00; P =.001; 31-90 days: HR, 1.36; P =.186; 91-365 days: HR, 0.90; P =.696) or severe COPD exacerbation (1-30 days: HR, 4.39; P <.001; 31-30 days: HR, 0.81; P =.764; 91-365 days: HR, 2.06; P =.087).

The study authors noted that these trends were observed regardless of CV risk at baseline or COPD exacerbation history.

“This analysis confirms the increased risk of CV [adverse event of special interest] during and in the first 30 days following an exacerbation seen in other studies, highlighting a need for exacerbation prevention and close patient monitoring following exacerbation events,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Dransfield M, Halpin D, Han ML, et al. Time-dependent risk of cardiovascular events following an exacerbation in patients with COPD: post hoc analysis from the IMPACT trial. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 1722.

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