COPD Found to Increase Risk of Cardiovascular Events in Patients With Hypertension

Chronic obstructive pulmonary disease (COPD) was found to increase the risk of cardiovascular and cerebral events, including stroke and myocardial infarction (MI), in patients who were also hypertensive, according to a recent study published in Scientific Reports.

“On the basis of these findings, it is necessary to routinely investigate the presence of COPD in hypertensive patients, aiming to a very early diagnosis and treatment,” wrote the investigators.

The study is the first to highlight the potential risks for fatal and nonfatal cerebro-cardiovascular events associated with COPD in patients with hypertension (HT).

Although essential HT is known to occur in more than 50% of patients with COPD, making it the most common comorbidity associated with COPD, little data exist to establish the prevalence of respiratory disease in patients with HT and whether COPD impacts clinical outcomes. The investigators noted that the lack of data may have to do with how often COPD is underdiagnosed in patients.

“Of interest, both conditions are often present in the same patient, probably because they share some common risk factors, contributing to the increase of the cardiovascular risk burden in a multiplicative manner,” wrote the investigators.

For the study, COPD was diagnosed using spirometry and disease severity was determined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Only patients classified as having GOLD 1 and 2 stages were analyzed, because they represented 97% of the study population.

The mean (SD) follow-up was 57 (27) months and included clinic visits every 6 months or mail-in questionnaires for patients who could not come into the clinic. Data were collected on the incidence of fatal and nonfatal stroke, fatal and nonfatal MI, and other causes of cardiovascular (CV) death, such as pulmonary embolism, malignant arrhythmia, end-stage heart failure, peripheral arterial disease, or aortic rupture.

Of 2195 patients with essential HT participating in the Catanzaro Metabolic Risk Factors Study in Italy, 1728 consecutive subjects referred to the investigators' Clinic Center were enrolled, followed, and divided into groups based on the presence or absence of COPD.

The mean age of the participants was 61 (12) years. Male participants accounted for 60.5% (n = 1046) of the study population, and 67.2% (n = 1161) of all participants were habitual smokers. Patients with HT and COPD represented 30.3% of the cohort and were generally older, male, and smokers.

During the follow-up period, there were 205 major adverse cardiovascular events (MACEs), of which 117 (57%) were due to coronary events, 77 (37%) were due to cerebrovascular events, and 11 (5%) were CV deaths. Of the CV deaths, 6 were due to arrhythmic causes and 5 were caused by pulmonary embolism. In addition to CV-related deaths, there were 35 non–CV-related deaths; 18 occurred in patients with HT only and 17 occurred in patients with HT and COPD (P = .029).

Compared with patients who only had HT, patients with HT and COPD had significantly higher CV events (72 vs 133 MACEs). The HT-and-COPD cohort also had 3 times the number of total and nonfatal MI compared with the patients with only HT. Additionally, the HT-and-COPD group had a 9-fold and 11-fold higher incidence in total and nonfatal stroke, respectively.

The presence of COPD increased the risk of total (HR, 9.053; 95% CI, 4.067-17.792) and nonfatal (HR, 10.847; 95% CI, 5.091-23.113) stroke considerably more than it did for MI, both total (HR, 1.920; 95% CI, 1.223-3.013) and nonfatal (HR, 1.881; 95% CI, 1.187-2.982).

The investigators identified several limitations to their findings, including that the observational design of the study impacted the ability to determine whether a cause-effect relationship between COPD and MACEs in patients with HT exists and that the inclusion of patients with GOLD stage 1 and 2 COPD prevents generalizability to patients with other GOLD stages.

Reference

Perticone M, Maio R, Caroleo B, et al. COPD significantly increases cerebral and cardiovascular events in hypertensives. Sci Rep. Published online April 12, 2021. doi:10.1038/s41598-021-86963-z