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Global Insights into Chronic Obstructive Pulmonary Disease and Coronary Artery Disease: A Systematic Review and
Yitian Zheng1,2, Zhenliang Hu3, Samuel Seery4,5
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, 100191 Beijing, China.
Insights
Chronic obstructive pulmonary disease (COPD) affects 14.2% of coronary artery disease (CAD) patients, increasing mortality and complications. Coronary artery bypass grafting may offer better revascularization outcomes than percutaneous coronary intervention.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- High prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) patients noted.
- Interactions and causes of COPD-CAD comorbidity remain uncertain.
- COPD is a leading comorbidity in CAD, impacting patient outcomes.
Purpose of the Study:
- To determine COPD prevalence in the global CAD population.
- To investigate the influence of COPD on CAD progression and outcomes.
- To analyze mortality and complication rates in comorbid COPD-CAD patients.
Main Methods:
- Meta-analysis of studies from PubMed, Web of Science, Embase, and grey literature up to November 2021.
- Calculation of COPD prevalence based on diagnostic methods (spirometry, ICD codes, self-report).
- Analysis of outcomes including all-cause mortality, cardiac death, myocardial infarction, stroke, heart failure, and revascularization.
Main Results:
- Average COPD prevalence in CAD patients is 14.2% (95% CI: 13.3-15.1).
- COPD-CAD patients exhibit higher rates of smoking, cardiovascular/respiratory complications, and mortality (HR 2.81).
- Increased risks for myocardial infarction, stroke, and respiratory failure observed in COPD-CAD patients.
Conclusions:
- Global COPD prevalence is significantly high among CAD patients.
- COPD-CAD comorbidity is associated with increased cardiovascular and respiratory complications and poorer outcomes.
- Coronary artery bypass grafting (CABG) may reduce revascularization needs without increasing mortality compared to percutaneous coronary intervention (PCI).
Background:
The high prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) has been acknowledged over the past decade, although the cause/s remain uncertain due to differences in diagnoses. COPD has also become a leading CAD comorbidity, although again little is known about its interactions. This meta-analysis explored COPD prevalence in the global CAD population, as well as the influence of COPD on CAD.
Methods:
PubMed, Web of Science, Embase, and grey literature were searched until 26th November 2021. The prevalence of COPD was calculated, and data were grouped according to COPD diagnostic methods, interventions, region, economic status, etc. Outcomes including all-cause death, cardiac death, myocardial infarction, revascularization, stroke, heart failure, and respiratory failure were analyzed. This study was registered with PROSPERO (CRD No.42021293270).
Results:
There was an average prevalence of 14.2% for COPD in CAD patients (95% CI: 13.3-15.1), with diagnostics of COPD through spirometry, International Classification of the Diseases (ICD codes), and self-reported methods. Comorbid COPD-CAD patients were more likely to be smokers and suffer from cardiovascular and respiratory complications (all odds ratios [OR] 1). COPD-CAD has higher mortality (hazard ratio [HR] 2.81, 95% CI: 2.40-3.29), and myocardial infarction, stroke, and respiratory failure rates (all HR 1). Coronary artery bypass graft (CABG) reduces the need for revascularization (HR 0.43, 95% CI: 0.20-0.94) compared to percutaneous coronary intervention (PCI), without increasing mortality.
Conclusions:
The global prevalence of COPD is particularly high in CAD patients. COPD-CAD patients are more likely to encounter cardiovascular and respiratory complications and endure poorer outcomes. Limited evidence suggests that CABG may reduce the need for revascularization without increasing mortality, although further research is required to confirm these observations.
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