Patients with chronic obstructive pulmonary disease (COPD) have a higher incidence of heart failure, ischemic heart disease, and atrial fibrillation than those without COPD, according to study findings published in BMJ Open Respiratory Research.
Investigators aimed to estimate the incidence of new-onset cardiovascular diseases (CVDs), including ischemic heart disease, atrial fibrillation, and heart failure, in real-world patients with COPD.
The researchers conducted an observational community-based study including 6223 patients with COPD and 137,028 individuals without COPD, analyzing primary care data from the Julius General Practitioners’ Network (almost 70 general practices in The Netherlands including more than 370,000 individuals) from January 2014 through February 2019. Patients in the COPD group (40-80 years of age) had a mean follow-up of 3.9 years.
Investigators calculated incidence of CVDs as number of cases per 1000 person-years according to COPD status. Incidence by age was estimated with groups of less than 65 years, 65 to 74 years, and more than 74 years. The researchers used Poisson regression analysis with person-time in years added as offset to calculate sex-adjusted and age-adjusted incidence rate ratios. Cox proportional hazard regression was used to calculate disease-free survival (excluding patients with any CVD at baseline).
Patients with COPD vs individuals without were older (mean age 64.1 years vs 55.3 years) and at baseline presented more cardiovascular risk factors and comorbidities (ischemic heart disease, 20.2% vs 5.6%; atrial fibrillation, 6.7% vs 2.2%; heart failure, 7.7% vs 1.1%).
Investigators found the incidence rates of new-onset ischemic heart disease, atrial fibrillation, and heart failure increased with age, though the highest incidence among patients with COPD for ischemic heart disease was most noticeable in the younger age group. Incidence rates were higher in men, independent of COPD diagnosis. When adjusted for sex and age, incidence rate ratios for patients with COPD were: ischemic heart disease, 1.69 (95% CI, 1.49-1.92); atrial fibrillation, 1.56 (95% CI, 1.38-1.77); heart failure, 2.96 (95% CI, 2.58-3.40).
Notably, with respect to heart failure, investigators found the incidence was significantly higher in patients with COPD vs without, for men and women, across all age groups.
In those with COPD, the researchers found a higher but not statistically significant incidence of atrial fibrillation in men vs women at any age, and ischemic heart disease incidence was not significantly different between sexes. In contrast, among those without COPD, researchers found that incidence of ischemic heart disease and atrial fibrillation was significantly higher in men vs women at any age.
Study limitations include the risk of disease misclassification, unknown high levels of CVD in patients with COPD, and the small number of cases in lower age categories in the COPD group.
“The incidence of the major chronic progressive heart diseases is higher in individuals with COPD compared with those without, with the highest incidence rate ratio observed for heart failure,” investigators concluded. They added that the greatest risk for CVD development was found in patients with COPD in the youngest age groups, and that “In young females…COPD seems to negate some of the premenopausal protection for all three CVDs.”
Groenewegen A, Zwartkruis VW, Smit LJ, et al. Sex-specific and age-specific incidence of ischemic heart disease, atrial fibrillation, and heart failure in community patients with chronic obstructive pulmonary disease. BMJ Open Respir Res. Published online December 9, 2022. doi:10.1136/bmjresp-2022-001307