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COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program
Stephen Sidney1, Michael Sorel, Charles P Quesenberry
1Division of Research, Kaiser Permanente Medical Care Program, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA. sxs@dor.kaiser.org
Insights
Patients with chronic obstructive pulmonary disease (COPD) face a significantly higher risk of cardiovascular disease (CVD) hospitalization and death. This increased risk is particularly pronounced in younger adults with COPD, highlighting the need for vigilant CVD monitoring and management.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is a major global health concern.
- Cardiovascular disease (CVD) is a leading cause of mortality worldwide.
- The relationship between COPD and CVD incidence requires further investigation.
Purpose of the Study:
- To determine the association between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality.
- To investigate whether COPD is an independent predictor of CVD events.
Main Methods:
- Retrospective matched cohort study.
- Utilized data from Northern California Kaiser Permanente Medical Care Program (KPNC).
- Included 45,966 COPD patients and an equal number of matched controls without COPD, followed for an average of 2.75-2.99 years.
Main Results:
- COPD patients had a significantly higher risk of hospitalization for all CVD end points (adjusted RR 2.09) and mortality (adjusted RR 1.68).
- Specific CVD risks included higher rates of congestive heart failure (CHF) and stroke.
- Younger patients (<65 years) and females with COPD exhibited a stronger association with CVD outcomes.
Conclusions:
- COPD is a significant predictor of CVD hospitalization and mortality.
- Younger adults with COPD require particularly careful monitoring and management of CVD risk.
- Integrated healthcare systems can facilitate large-scale cohort studies for understanding disease associations.
Study Objectives:
To determine the relationship between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality.
Design:
Retrospective matched cohort study.
Setting:
Northern California Kaiser Permanente Medical Care Program (KPNC), a comprehensive prepaid integrated health-care system.
Patients Or Participants:
Case patients (n = 45,966) were all KPNC members with COPD who were identified during a 4-year period from January 1996 through December 1999. An equal number of control subjects without COPD were selected from KPNC membership and were matched for gender, year of birth, and length of KPNC membership.
Measurements And Results:
Follow-up conducted for hospitalization and mortality from CVD end points through December 31, 2000. CVD study end points included cardiac arrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure (CHF), stroke, pulmonary embolism, all of the aforementioned study end points combined, other CVD, and all CVD end points. The mean follow-up time was 2.75 years for case patients and 2.99 years for control subjects. The risk of hospitalization was higher in COPD case patients than in control subjects for all CVD hospitalization and mortality end points. The relative risk (RR) for hospitalization for the composite measure of all study end points was 2.09 (95% confidence interval [CI], 1.99 to 2.20) after adjustment for gender, preexisting CVD study end points, hypertension, hyperlipidemia, and diabetes, and ranged from 1.33 (stroke) to 3.75 (CHF). The adjusted RR for mortality for the composite measure of all study end points was 1.68 (95% CI, 1.50 to 1.88), ranging from 1.25 (stroke) to 3.53 (CHF). Younger patients (ie, age < 65 years) and female patients had higher risks than older and male participants.
Conclusions:
COPD was a predictor of CVD hospitalization and mortality over an average follow-up time of nearly 3 years. The finding of a stronger relationship of COPD to CVD outcomes in patients < 65 years of age suggests that CVD risk should be monitored and treated with particular care in younger adults with COPD.
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