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Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review
Ana Sá-Sousa1,2, Cidália Rodrigues3, Cristina Jácome1,2
1MTG Research and Development Lab, 4200-604 Porto, Portugal.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face a significantly higher risk of cardiovascular disease (CVD). This systematic review highlights increased risks for conditions like heart attack and heart failure, emphasizing the need for proactive cardiovascular monitoring in COPD patients.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Epidemiology
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern.
- Patients with COPD exhibit a higher prevalence of cardiovascular disease (CVD) comorbidities.
- A comprehensive review of CVD risk in COPD patients is essential for improved patient outcomes.
Purpose of the Study:
- To systematically review and synthesize evidence on the risk of various cardiovascular diseases in patients diagnosed with COPD.
- To quantify the association between COPD and specific CVDs including myocardial infarction, heart failure, and stroke.
Main Methods:
- Systematic literature search of PubMed, Web of Science, and SCOPUS databases up to September 2023.
- Inclusion of observational studies on adult COPD patients (GOLD criteria, spirometry, or physician diagnosis) reporting CVD risk.
- Narrative synthesis of data from 24 studies involving over 3.4 million COPD patients and 31 million controls.
Main Results:
- Patients with COPD demonstrated a significantly higher risk of overall CVD, myocardial infarction (MI), ischemic heart disease (IHD), heart failure, and angina.
- Elevated risks were also observed for atrial fibrillation (AF), stroke, sudden cardiac death, pulmonary hypertension, and peripheral vascular disease, though evidence varied.
- The majority of included studies (17/24) were conducted in Europe.
Conclusions:
- Individuals with COPD possess an elevated risk of developing cardiovascular diseases compared to the general population.
- Close monitoring of cardiovascular risk factors and targeted interventions are crucial for managing patients with COPD.
- This review emphasizes the need for integrated care strategies addressing both COPD and CVD management.
Abstract:
Background/Objectives: A comprehensive and up-to-date review on cardiovascular disease (CVD) risk in patients with COPD is needed. Therefore, we aimed to systematically review the risk of a range of CVD in patients with COPD. Methods: We searched three databases (Pubmed, Web of Science, SCOPUS) from inception to September 2023 using terms related to COPD and CVD. Observational studies were included if they (1) were conducted in adults with a diagnosis of COPD based on the GOLD criteria, spirometry, physician diagnosis, or review of electronic health records; (2) reported the risk of CVD, namely of myocardial infarction (MI), ischaemic heart disease (IHD), atrial fibrillation (AF), heart failure, cerebrovascular disease, pulmonary hypertension, and peripheral vascular disease, compared with a control population using a measure of risk. A narrative synthesis was used. Results: Twenty-four studies from 2015 to 2023, mainly from Europe (n = 17), were included. A total of 3,485,392 patients with COPD (43.5-76.0% male; 63.9-73.5 yrs) and 31,480,333 (40.0-55.4% male, 49.3-70.0 yrs) controls were included. A higher risk of CVD in patients with COPD was evident regarding overall CVD, MI, IHD, heart failure, and angina. Higher risks of arrhythmia and AF, stroke, sudden cardiac death/arrest, pulmonary embolism, pulmonary hypertension, and peripheral vascular disease were also found, although based on a small amount of evidence. Conclusions: Patients with COPD have a higher risk of CVD than the general population or matched controls. This review underscores the need for vigilant and close monitoring of cardiovascular risk in individuals with COPD to inform more precise preventive strategies and targeted interventions to enhance their overall management.
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