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Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study
Barbara Bonnesen1, Pradeesh Sivapalan1, Anna Kjær Kristensen1
1Section of Respiratory Medicine, Dept of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Insights
Patients with both chronic obstructive pulmonary disease (COPD) and asthma face a significantly higher risk of cardiovascular events. This comorbidity increases the likelihood of major adverse cardiac events by 20-25%.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Chronic low-grade inflammation, characteristic of asthma, is linked to increased cardiovascular event risk.
- The study investigates if asthma exacerbates cardiovascular risk in patients with chronic obstructive pulmonary disease (COPD).
Purpose of the Study:
- To evaluate the risk of acute cardiovascular events in patients diagnosed with both COPD and asthma compared to those with COPD alone.
Main Methods:
- A nationwide, multicenter, retrospective cohort study of Danish outpatients with COPD.
- Propensity-score matching (1:2 ratio) was used to compare patients with COPD and asthma against those with COPD without asthma.
- The primary endpoint was severe major adverse cardiac events (MACE), including fatal cardiovascular events and those requiring revascularization or hospitalization.
Main Results:
- The study included 52,386 Danish patients with COPD; 20.1% had comorbid asthma.
- Patients with COPD and asthma showed a higher risk of MACE compared to COPD-only patients, with hazard ratios of 1.25 (with pre-existing cardiovascular disease) and 1.22 (without pre-existing cardiovascular disease).
- This represents an increased risk of 20-25% for MACE in the COPD and asthma group.
Conclusions:
- Asthma, as a comorbidity in COPD patients, is associated with a substantial increase in cardiovascular event risk.
- The findings suggest that asthma should be considered a significant risk factor for cardiovascular events in individuals with COPD.
Background:
Chronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated whether patients with COPD and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma.
Methods:
Nationwide multicentre retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity-score matched 1:2 to patients with COPD without asthma. The primary end-point was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularisation or hospitalisation.
Results:
A total of 52 386 Danish patients with COPD were included; 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity-score matched: 3690 patients with COPD and asthma versus 7236 patients with COPD without asthma, and similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205). The risk of MACE was higher among patients with asthma and COPD versus COPD without asthma: hazard ratio (HR) 1.25 (95% CI 1.13-1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (95% CI 1.06-1.41, p=0.005) for patients without pre-existing cardiovascular disease.
Conclusion:
Among patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20-25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients.
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