Could COPD Serve as a Marker of Cardiovascular Morbidity, Mortality?

Patients with chronic obstructive pulmonary disease (COPD) experience significant cardiovascular (CV) morbidity and mortality, according to an analysis of a case-control study published in COPD: Journal of Chronic Obstructive Pulmonary Disease.

Researchers used baseline data from 2 randomized controlled trials (Heart Attack Prevention Programme for You [HAPPY] London; ClinicalTrials.gov Identifier: NCT01911910 and the Relovair^® Lung Deflation Study; ClinicalTrials.gov Identifier: NCT01691885) that were performed between 2012 and 2015. They sought to evaluate whether COPD modifies future CV risk to establish if a COPD variable should be considered in models of risk prediction.

In this current study of 90 eligible participants, a total of 26 individuals with COPD and lung hyperinflation were propensity-matched for a 10-year global CV risk score (QRISK2) with 26 control participants who had normal lung function. All of the patients underwent lung function, cardiac magnetic resonance imaging, and arterial stiffness measurements. The main study outcomes included differences in pulse wave velocity (PWV), aortic distensibility, and total arterial compliance (TAC).

Results showed that PWV (mean difference, 1.0 m/s; 95% CI, 0.02-1.92; P =.033) and TAC (mean difference, -0.27 mL/m²/mm Hg; 95% CI, 0.39-0.15; P <.001) were significantly and adversely affected among participants with COPD compared with the control group. The mean difference in PWV equated to a sex, age, and risk factor adjusted increase in relative risk for CV events and mortality of 14% and 15%, respectively. No differences in aortic distensibility were observed between the 2 groups.

QRISK2 was significantly associated with PWV in multivariate analysis among the entire cohort. The link between QRISK2 and PWV was modified by the presence of COPD, with the interaction term achieving significance (P =.014). Furthermore, in multivariate analysis, forced expiratory volume in 1 second (FEV₁) and pulse were both significantly associated with TAC (P =.041 and P =.003, respectively).

The investigators concluded that CV risk algorithms may benefit from the addition of a COPD variable to help improve risk prediction and guide the management of patients. Additional research on the subject is warranted.

Disclosure: These clinical trials were supported by GlaxoSmithKline and SmithKline Beecham Pharma. Please see the original reference for a full list of authors’ disclosures.

Reference                                                                                                                        

Khanji MY, Stone IS, Boubertakh R, Cooper JA, Barnes NC, Petersen SE. Chronic obstructive pulmonary disease as a predictor of cardiovascular risk: a case-control study [published online December 13, 2019]. COPD. doi:10.1080/15412555.2019.1694501