SESSION TYPE: Arrhythmia and Coronary Artery Disease
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: Atherosclerotic cardiovascular and cerebrovascular disease(CCVD) is an important comorbidity associated with chronic obstructive pulmonary disease(COPD). We compared the prevalence of CCVD between COPD and non-COPD subjects. Additionally, among subjects without pre-existent CCVD, we compared the short-term(10-year) and lifetime risk of development of CCVD in the two study groups.
METHODS: Pooled data from the NHANES-2007-2010 were utilized. CCVD was defined as self-reported history of stroke, angina/heart attack, coronary artery disease or congestive heart failure. COPD was defined as either a self-reported history of emphysema or FEV1/FVC ratio<70% on serial spirometric assessment before and after administration of a bronchodilator. Based on predicted risk per standard Framingham criteria, subjects without pre-existing CCVD were classified into three groups: high short-term risk, low short-term/high lifetime risk, low short-term/low lifetime risk for development of CCVD.
RESULTS: The prevalence(SE) of CCVD was estimated as 20.0(2.1)% and 7.4(0.5)% in COPD and non-COPD groups(p<0.001). Among subjects with CCVD, the prevalence of active/former smokers was significantly higher in the COPD population(92.4%) as compared to controls(58.1%, p<0.001). Using multivariate analysis, COPD was demonstrated to be an independent risk factor for prevalent CCVD [OR(95%CI):1.7(1.1-2.6)], after adjustment for demographic and clinical characteristics including smoking. Among subjects without CCVD, there were significant differences in predicted cardiovascular risk between the two groups. In the non-COPD category, prevalence of subjects with high short-term risk, low short-term/high lifetime risk and low short-term/low lifetime risk were 18.9%, 62.7% and 18.4% respectively. In the COPD category, the corresponding prevalence estimates were calculated as 35.8%, 53.2% and 11.1% respectively. Predicted 30-year risk(SE) of CCVD was estimated as 47.2(0.8)% in the COPD group, which was significantly higher than 37.9(0.5)% in the non-COPD group(p<0.001).
CONCLUSIONS: We observed a significantly increased prevalence of CCVD among subjects with COPD. Among subjects without pre-existent CCVD, the risk of developing CCVD in the future was significantly higher in the COPD group as compared to the non-COPD group.
CLINICAL IMPLICATIONS: Aggressive cardiovascular risk factor modification is imperative towards prevention of development of CCVD among patients with COPD.
DISCLOSURE: The following authors have nothing to disclose: Shikhar Agarwal, Haala Rokadia, Todd Senn
No Product/Research Disclosure InformationCleveland Clinic, Cleveland, OH