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The Disproportionate Burden of Cardiovascular Disease in Mild-to-Moderate COPD
Wen Zhang1,2, Jian Wen1, Si Yuan Chew2
1Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China.
Insights
Cardiovascular disease (CVD) is more prevalent in mild chronic obstructive pulmonary disease (COPD) and predicts mortality. In severe COPD, multidimensional severity, not CVD, predicts survival, suggesting tailored screening and prognosis strategies.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD).
- The relationship between COPD severity and cardiovascular burden requires further investigation.
- This study examined the association between COPD severity and CVD prevalence, and their impact on long-term survival.
Purpose of the Study:
- To investigate the association between COPD severity and CVD prevalence.
- To evaluate the independent and joint effects of COPD and CVD on long-term survival.
- To determine optimal prognostic indicators across different COPD severity stages.
Main Methods:
- A multicenter cohort study of 553 stable COPD patients.
- COPD severity stratified by GOLD grades and the BODEx index.
- Logistic regression and Cox proportional hazards models analyzed CVD prevalence and mortality predictors.
Main Results:
- CVD prevalence was paradoxically lower in severe-to-very severe COPD (42.3%) compared to mild-to-moderate COPD (57.7%).
- Severe airflow limitation was independently associated with lower odds of CVD.
- CVD predicted mortality in early-stage COPD, while the BODEx score predicted mortality in advanced COPD.
Conclusions:
- Cardiovascular disease burden is highest in mild-to-moderate COPD and significantly impacts mortality.
- In advanced COPD, multidimensional severity (BODEx index) is a stronger predictor of survival than CVD.
- Early CVD screening in mild COPD and multidimensional indices for advanced COPD prognosis are recommended.
Background:
Cardiovascular disease (CVD) is a major comorbidity in chronic obstructive pulmonary disease (COPD). However, whether cardiovascular burden increases with the severity of COPD requires more nuanced investigation. This study investigated the association between COPD severity and CVD prevalence, and evaluated their independent and joint effects on long-term survival.
Methods:
This multicenter cohort study included 553 stable COPD patients. Disease severity was stratified by GOLD grades and the multidimensional BODEx index. Logistic regression and Cox proportional hazards models were used to evaluate CVD prevalence across severity stages and identify predictors of all-cause mortality.
Results:
Patients were classified as mild-to-moderate (GOLD 1-2; 57.7%) or severe-to-very severe (GOLD 3-4; 42.3%). A clear paradox emerged: CVD prevalence was significantly lower in severe-to-very severe COPD compared to mild-to-moderate disease (45.7% vs. 59.6%, P=0.001). Adjusted analysis indicated that severe airflow limitation was independently associated with lower odds of CVD (OR 0.68, P=0.038). Notably, CVD was a significant mortality predictor only in early-stage disease. Conversely, in advanced COPD, the multidimensional BODEx score >4 emerged as the strongest independent predictor of mortality (HR 2.19, P<0.001), rendering CVD history statistically non-significant (P=0.10).
Conclusion:
CVD burden is highest in mild-to-moderate stages, where it significantly drives mortality. In advanced disease, overall multidimensional severity (BODEx index) supersedes CVD to determine survival. These findings emphasize prioritizing early cardiovascular screening in mild COPD while utilizing multidimensional indices for advanced prognosis.
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