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Original Research: COPD |

Cardiovascular Comorbidity in COPDCardiovascular Disease in COPD: Systematic Literature Review

Hana Müllerova, PhD; Alvar Agusti, MD, PhD; Sebhat Erqou, MD, PhD; Douglas W. Mapel, MD, MPH, FCCP
Author and Funding Information

From Worldwide Epidemiology (Dr Müllerova), GlaxoSmithKline R&D, Uxbridge, England; Thorax Institute (Dr Agusti), Hospital Clinic, IDIBAPS, Universitat de Barcelona and FISIB, CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain; Weill Cornell Medical College (Dr Erqou), New York, NY; and Lovelace Clinic Foundation (Dr Mapel), Albuquerque, NM.

Correspondence to: Hana Müllerova, PhD, Worldwide Epidemiology, GlaxoSmithKline R&D, Bldg 9, Iron Bridge Rd, Stockley Park W, Uxbridge, Middlesex, UB11 1BT, England; e-mail: hana.x.muellerova@gsk.com


Funding/Support: This study was sponsored by GlaxoSmithKline plc [study code WEUSKOP4140].

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


Chest. 2013;144(4):1163-1178. doi:10.1378/chest.12-2847
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Background:  Cardiovascular disease (CVD) is common among patients with COPD. However, it is not clear whether this is due to shared risk factors or if COPD increases the risk for CVD independently. This study aimed to provide a systematic review of studies that investigated the association between COPD and CVD outcomes, assessing any effect of confounding by common risk factors.

Methods:  A search was conducted in MEDLINE (via PubMed) for observational studies published between January 1990 and March 2012 reporting cardiovascular comorbidity in patients with COPD (or vice versa).

Results:  Of the 7,322 citations identified, 25 studies were relevant for this systematic review. Twenty-two studies provided an estimate for CVD risk in COPD, whereas four studies provided estimates of COPD risk in CVD. The crude prevalence for the aggregate CVD category ranged from 28% to 70%, likely due to differences in populations studied and CVD definitions; unadjusted rate ratio (RR) estimates of unspecified CVD among patients with COPD compared with patients without COPD ranged from 2.1 to 5.0. The association between COPD and CVD persisted after adjustment for shared risk factors in the majority of the studies. Two studies found a relationship between the severity of airflow limitation and CVD risk. Increased RRs were observed for individual CVD types, but their estimates varied considerably for congestive heart failure, coronary heart disease, arrhythmias, stroke, arterial hypertension, and peripheral arterial disease.

Conclusions:  Available observational data support the hypothesis that COPD is associated with an increased risk of CVD.

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