The magnitude of increased risk for cardiovascular disease (CVD) among persons with COPD is uncertain. The purpose of this study was to assess the risk of CVD among persons diagnosed and treated for COPD.
A cohort study was conducted using the Northern California Kaiser Permanente Medical Care Program (KPMCP) among persons >=40 years old who were diagnosed with COPD from January 1996 to December 1999, and who received >=2 prescriptions for a bronchodilator within 6 months of diagnosis. Subjects were matched by age, gender and duration of plan membership to a randomly selected control without COPD. COPD diagnosis, selected CV outcomes and smoking behavior were validated through chart review and a survey administered to a subset of participants. Prevalence of CV risk factors and conditions, and incidence of CVD were measured. Odd ratios for prevalence, risk ratios for incidence and 95% confidence intervals were estimated.
Subjects with COPD (n=45,966) constituted 3.7% of the eligible population; 25,468 (55%) male and 20,498 (45%) female. The mean age was 64 years; 15% were <50 years; almost half the cohort was <65 years and 10% were >=80 years old. During an average follow-up period of three years, incidence of any hospitalization for CV causes in COPD subjects was elevated compared to controls (RR=2.3, 95% CI 2.2, 2.4), as were cause-specific hospitalizations for CV conditions. Subjects with COPD were more likely to die from all causes (RR=3.4, 95% CI 3.3, 3.6), from CV-related causes combined (RR=2.4, 95% CI 2.2, 2.5), and from major cause-specific CV conditions: congestive heart failure (RR=4.9, 95% CI 3.4, 7.2), acute myocardial infarction (RR=2.3, 95% CI 2.0, 2.7), stroke (RR=1.5, 95% CI 1.2, 1.8), pulmonary embolism (RR=2.4, 95% CI 1.2, 4.7) and atrial fibrillation (RR=1.6, 95% CI 0.3, 9.6).
Persons with diagnosed and treated COPD had approximately two to threefold increased risk of hospitalizations and deaths due to CVD.
Persons with diagnosed and treated COPD have an increased risk of hospitalizations and deaths due to CVD.
C. de Luise, Boehringer Ingelheim and Pfizer