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Global Incidence of Cardiovascular Diseases Attributable to Chronic Obstructive Pulmonary Disease: A Modelling Study
Lu Xu1, Xuelian Chen2, Xueyun Mao3
1Department of Science Research, Beijing Hospital, National Center for Gerontology; National Clinical Research Center for Gerontology; The Key Laboratory of Geriatrics of NHC; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Background:
Population-based evidence quantifying the incidence burden of cardiovascular diseases (CVDs) attributable to chronic obstructive pulmonary disease (COPD) remains limited. This study aimed to estimate the global incidence burden of CVDs attributable to COPD.
Methods:
Data for individuals aged ≥45 years were obtained from the Global Burden of Disease (GBD) 2021 study. Population attributable fractions (PAFs) were calculated using Levin's formula, based on COPD prevalence from GBD 2021 and pooled relative risks derived and re-pooled from published systematic reviews and meta-analyses. The attributable incidence counts and age-standardized incidence rates (ASIRs) were derived for total CVD and four specific types: ischemic heart disease (IHD), lower extremity peripheral arterial disease (LE-PAD), atrial fibrillation and flutter (AF), and stroke. Trends from 1990 to 2021 were assessed using estimated annual percentage change (EAPC). Future burden was projected to 2050 using the Bayesian age-period-cohort models.
Results:
In 2021, the global ASIR of total CVD attributable to COPD was 248.93 per 100,000 (95% uncertainty interval (UI): 227.03 to 271.05). Among specific CVDs, IHD had the highest ASIR (93.44 per 100,000), followed by LE-PAD (49.16), AF (24.55), and stroke (23.30). The burden was highest in Eastern Europe, Central Asia, and North Africa and the Middle East, and in low-middle SDI regions. From 1990 to 2021, incident counts of all CVD types more than doubled (EAPC: 2.16% to 2.80%), whereas ASIRs declined modestly (EAPC: -0.89% to -0.10%). By 2050, ASIRs for LE-PAD and AF are projected to increase markedly (EAPC: 3.03% and 3.04%, respectively), with particularly pronounced increases among females.
Conclusion:
Modelled estimates suggest that COPD accounts for approximately 11% of incident CVD cases among adults aged ≥ 45 years globally. These findings support consideration of COPD in future cardiovascular prevention strategies and risk assessment frameworks.
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