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Impact of concurrent COPD and cardiovascular disease on mortality
Hyun Woo Lee1, Sang Hyuk Kim2, Chin Kook Rhee3
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Insights
Coexisting chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) significantly increase mortality risk. Integrated management is crucial for this high-risk phenotype.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist.
- Shared risk factors contribute to their common occurrence.
- The population-level mortality burden of coexisting COPD and CVD requires detailed characterization.
Purpose of the Study:
- To quantify the cause-specific and absolute mortality risks associated with coexisting COPD and CVD.
- To identify the mortality burden in individuals with both conditions compared to those with neither.
Main Methods:
- A population-based cohort study utilizing UK Biobank data.
- Participants were stratified into four groups based on baseline COPD and CVD status.
- Multivariable Cox models and competing-risk analyses assessed mortality outcomes, including all-cause, respiratory, and cardiovascular mortality.
Main Results:
- Coexisting COPD and CVD markedly increased all-cause mortality risk (aHR, 2.207).
- Respiratory-specific and cardiovascular-specific mortality risks were also substantially elevated.
- The absolute excess risk of all-cause mortality at 10 years was 13.9 percentage points for individuals with both conditions.
Conclusions:
- Coexisting COPD and CVD represent a distinct high-risk phenotype.
- This phenotype is associated with a significantly increased absolute burden of all-cause and cause-specific mortality.
- Integrated cardiopulmonary risk management is essential for this patient group.
Background:
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist and share common risk factors. However, the mortality burden associated with their co-occurrence has not been fully characterized at the population level, particularly with respect to cause-specific and absolute risks.
Methods:
We conducted a population-based cohort study using data from UK Biobank. Participants were classified into four groups according to baseline COPD and CVD status. The primary outcome was all-cause mortality, and secondary outcomes included respiratory, cardiovascular, and lung cancer mortality. Multivariable Cox proportional-hazards models and competing-risk analyses were used to estimate adjusted hazard ratios (HRs). Absolute risks, risk differences, and numbers needed to harm (NNH) were calculated to quantify excess mortality burden.
Results:
Among 293,948 participants followed for a median of 12.9 years, 3.9% had coexisting COPD and CVD at baseline. Compared to participants without either condition, those with both had a markedly increased risk of all-cause mortality (adjusted HR, 2.207 [95% confidence interval, 2.113-2.305]). Risks of respiratory-specific and cardiovascular-specific mortality were also substantially elevated. Although the COPD/CVD interaction was less than multiplicative on the HR scale, the absolute mortality burden was greatest among participants with both conditions. At 10 years, the excess absolute risk of all-cause mortality associated with coexisting COPD and CVD was 13.9 percentage points, corresponding to an NNH of 7.2.
Conclusion:
Coexisting COPD and CVD defines a distinct high-risk phenotype with a significantly increased absolute burden of all-cause and cause-specific mortality, underscoring the need for integrated cardiopulmonary risk management.
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