Long-term cardiovascular risk after severe exacerbation of COPD: a population-based cohort study

Exacerbation of COPD (ECOPD) has been linked to increased cardiovascular disease (CVD) risk within the first year, yet longer term risk is unclear. We aimed to investigate the short-term and long-term CVD risks after severe ECOPD.

Patients with self-reported or spirometry-detected COPD at baseline and patients with newly documented COPD during follow-up were included from the China Kadoorie Biobank. Multiple data sources were used to collect information on ECOPD hospitalisation and CVD incidence during follow-up. Time-dependent Cox regression models were used to estimate the hazard ratios and 95% confidence intervals for each risk period following ECOPD compared to the baseline period.

Of the 46 514 patients included, 48.2% had screen-detected COPD, 26.2% had self-reported COPD and 25.6% had newly documented COPD. During a median 11-year follow-up, 1185 acute myocardial infarction, 5778 other ischaemic heart disease, 1078 heart failure, 2390 pulmonary heart disease, 4989 ischaemic stroke and 1648 intracerebral haemorrhage cases occurred. Post-ECOPD risks of all outcomes were prominently elevated, with first-week hazard ratios (95% CI) of 8.60 (5.40-13.70), 6.68 (5.16-8.65), 10.98 (6.74-17.89), 24.76 (19.40-31.60), 3.11 (2.16-4.48) and 2.40 (1.27-4.54), respectively. The risks diminished thereafter but could persist for 6 years or longer. All three categories of patients with COPD faced increased risks of most outcomes, with patients with COPD at baseline bearing higher post-ECOPD risks of other ischaemic heart disease and pulmonary heart disease.

CVD risks increased considerably after ECOPD, with risks of cardiac diseases and ischaemic stroke increased for 6 years or longer. Patients with screen-detected COPD had a similar burden of ECOPD and subsequent CVD to patients with doctor-diagnosed COPD.