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Original Research: Pulmonary Vascular Disease |

Comorbid Conditions and Outcomes in Patients With Pulmonary Arterial HypertensionPulmonary Arterial Hypertension Comorbidities: A REVEAL Registry Analysis

Abby D. Poms, BS, RRT; Michelle Turner, MS; Harrison W. Farber, MD, FCCP; Leslie A. Meltzer, PhD; Michael D. McGoon, MD, FCCP
Author and Funding Information

From the Duke University School of Medicine (Ms Poms), Durham, NC; ICON Late Phase & Outcomes Research (Ms Turner), San Francisco, CA; Boston University School of Medicine (Dr Farber), Boston, MA; Actelion Pharmaceuticals US, Inc (Dr Meltzer), South San Francisco, CA; and Mayo Clinic (Dr McGoon), Rochester, MN.

Correspondence to: Abby D. Poms, BS, RRT, Duke University School of Medicine, Box 102351, Durham, NC 27710; e-mail: abby.poms@duke.edu


Funding/Support: Funding and support for the REVEAL Registry was provided by Cotherix Inc and its affiliate Actelion Pharmaceuticals US Inc. Funding for preparation of this manuscript was provided by Actelion Pharmaceuticals US Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):169-176. doi:10.1378/chest.11-3241
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Background:  Comorbidities can affect disease progression and/or response to treatment in various conditions. Comorbid conditions are prevalent in patients with pulmonary arterial hypertension (PAH); however, their effect on patient outcomes remains unknown.

Methods:  We evaluated the effect on functional class (FC), 6-min walk test distance (6MWD), and survival of the seven most common, comorbid conditions at enrollment in patients with PAH from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry): hypertension, clinical depression, type 2 diabetes mellitus (diabetes), obesity, COPD, sleep apnea, and thyroid disease.

Results:  Patients with COPD or diabetes had the shortest 6MWD at enrollment (304.5 and 304.6 m, respectively) vs other comorbidities. Adjusted linear regression for 6MWD at enrollment revealed significant reductions among patients who were hypertensive, obese, diabetic, or had COPD (P < .001). A larger proportion of patients who were obese or had COPD were FC III/IV vs FC I/II at enrollment (P < .001). There was a greater risk for death among patients with diabetes (hazard ratio [HR], 1.73; 95% CI, 1.40-2.13; P < .001) or COPD (HR, 1.59; 95% CI, 1.34-1.90; P < .001), but there was a reduced risk for death in patients who were obese (HR, 0.73; 95% CI, 0.61-0.86; P < .001).

Conclusions:  Compared with other analyzed comorbidities in patients with PAH, hypertension, obesity, diabetes, and COPD were associated with significantly worse 6MWD; obesity and COPD were associated with worse FC; and diabetes and COPD were associated with increased risk for death. Further investigation of the effects of treating these comorbidities in patients with PAH is warranted.

Trial registry:  ClinicalTrials.gov; Identifier: NCT00370214; URL: www.clinicaltrials.gov

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