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Published on: August 24, 2019
Cardiovascular risk prediction using physical performance measures in COPD: results from a multicentre observational
Jilles M Fermont1,2, Marie Fisk3, Charlotte E Bolton4
1Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK jmf88@medschl.cam.ac.uk.
Insights
Predicting cardiovascular risk in COPD patients is crucial. The 6-minute walk test (6MWT) significantly improves prediction of cardiovascular hospitalisation in individuals with chronic obstructive pulmonary disease (COPD).
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD).
- Traditional cardiovascular risk scores may not accurately predict CVD risk specifically in COPD populations.
- The utility of alternative markers for enhancing CVD risk prediction in COPD remains unclear.
Purpose of the Study:
- To evaluate the predictive value of conventional CVD risk factors in individuals with COPD.
- To determine if additional markers can improve CVD risk prediction beyond conventional factors in COPD patients.
Main Methods:
- Utilized data from the Evaluation of the Role of Inflammation in Chronic Airways disease cohort (n=714) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV COPD.
- Collected prospective data on hospitalizations and mortality over a median of 4.6 years.
- Assessed baseline markers including aortic pulse wave velocity (aPWV), carotid intima-media thickness (CIMT), C-reactive protein (CRP), fibrinogen, spirometry, Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) Index, 6-minute walk test (6MWT), and 4-meter gait speed (4MGS).
Main Results:
- Out of 714 participants, 27% experienced CV hospitalization, and 6 died from CVD.
- Conventional risk models had a C-statistic of 0.689; aPWV and CIMT did not improve prediction.
- CRP, fibrinogen, GOLD stage, BODE Index, 4MGS, and 6MWT were associated with outcomes (p<0.05), but only 6MWT improved model discrimination (C=0.727).
Conclusions:
- Poor physical performance, as measured by the 6-minute walk test (6MWT), enhances the prediction of cardiovascular hospitalisation in COPD patients.
- The 6MWT is a valuable tool for improving cardiovascular risk stratification in individuals with COPD.
Objectives:
Although cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD. Traditional CV risk scores have been tested in different populations but not uniquely in COPD. The potential of alternative markers to improve CV risk prediction in individuals with COPD is unknown. We aimed to determine the predictive value of conventional CVD risk factors in COPD and to determine if additional markers improve prediction beyond conventional factors.
Design:
Data from the Evaluation of the Role of Inflammation in Chronic Airways disease cohort, which enrolled 729 individuals with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV COPD were used. Linked hospital episode statistics and survival data were prospectively collected for a median 4.6 years of follow-up.
Setting:
Five UK centres interested in COPD.
Participants:
Population-based sample including 714 individuals with spirometry-defined COPD, smoked at least 10 pack years and who were clinically stable for >4 weeks.
Interventions:
Baseline measurements included aortic pulse wave velocity (aPWV), carotid intima-media thickness (CIMT), C reactive protein (CRP), fibrinogen, spirometry and Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) Index, 6 min walk test (6MWT) and 4 m gait speed (4MGS) test.
Primary And Secondary Outcome Measures:
New occurrence (first event) of fatal or non-fatal hospitalised CVD, and all-cause and cause-specific mortality.
Results:
Out of 714 participants, 192 (27%) had CV hospitalisation and 6 died due to CVD. The overall CV risk model C-statistic was 0.689 (95% CI 0.688 to 0.691). aPWV and CIMT neither had an association with study outcome nor improved model prediction. CRP, fibrinogen, GOLD stage, BODE Index, 4MGS and 6MWT were associated with the outcome, independently of conventional risk factors (p<0.05 for all). However, only 6MWT improved model discrimination (C=0.727, 95% CI 0.726 to 0.728).
Conclusion:
Poor physical performance defined by the 6MWT improves prediction of CV hospitalisation in individuals with COPD.
Trial Registration Number:
ID 11101.
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