Early cardiovascular vulnerability after acute exacerbation of COPD: a time-windowed systematic review and evidence...

Cardiovascular events appear to cluster after acute exacerbation of chronic obstructive pulmonary disease (COPD), but the timing, severity gradient, and implications for respiratory follow-up remain incompletely organized.

PubMed, Embase, Scopus, and Web of Science were searched from inception to 1 May 2026. Adult observational studies and post hoc trial analyses were eligible when they evaluated clinically diagnosed cardiovascular events during or after exacerbations of COPD, asthma, or bronchiectasis. COPD was treated as the primary evidence base. Because designs, endpoints, severity definitions, comparators, and risk windows differed materially, results were synthesized as a time-windowed evidence map rather than as a pooled meta-analysis.

The search identified 8,027 records; 4,866 unique records were screened, 55 full texts were assessed, and 34 records were retained for quantitative, sensitivity, or narrative evaluation. The extracted matrix contained 110 effect estimates, of which 101 related to COPD and 57 fell within 30-day windows after time-window harmonization. Early risk was consistently higher than later risk, especially after severe or hospitalized COPD exacerbations. Signals were observed for coronary events, ischemic stroke, heart failure, atrial fibrillation or arrhythmia, cardiovascular death, and composite severe cardiovascular outcomes. Asthma and bronchiectasis evidence was sparse and exploratory.

Severe or hospitalized COPD exacerbation identifies a short cardiovascular vulnerability window, most consistently during the first month. The practical contribution is not a single pooled risk estimate, but a clinically interpretable map showing when respiratory recovery should be treated as cardiopulmonary transition-of-care.