Researchers Identify Which COPD Markers Impact CVD Outcomes, Mortality

Frequent and severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD), as well as increased breathlessness, is associated with the risk of cardiovascular disease (CVD) outcomes and mortality in patients with COPD, according to a new study. In contrast, the rate of forced expiratory volume in 1 second (FEV₁) decline had no association with composite CVD outcomes.

According to the researchers, this is the first large observational study to assess the relationship between accelerated FEV₁ decline and the risk of CVD outcomes and mortality for patients with COPD.

Data analyzed in the study was drawn from over 36,000 patients from the Clinical Practice Research Datalink primary care dataset.

During a mean follow-up of 3.6 years, 6110 (16.8%) patients experienced a CVD event. Over the 3.6 years, the median rate of FEV₁ decline -19.4 ml/year (IQR, -40.5 to 1.9). One in 4 patients included in the study experienced accelerated FEV1 decline (>-40.5 ml/year).

The researchers observed that accelerated FEV₁ decline did not appear to impact the risk of composite CVD events in both the unadjusted analysis (HRadj = 0.99; 95% CI, 0.93–1.05) and the fully adjusted analysis (HRadj=0.98; 95% CI, 0.90–1.06).

There was also no association seen between FEV₁ decline and individual CVD outcomes such as heart failure (HRadj 0.99; 95% CI, 0.83-1.20); myocardial infarction (HRadj 0.89; 95% CI, 0.70-1.12); stroke (HRadj 1.01; 95% CI: 0.82- 1.23); atrial fibrillation (HRadj 0.97; 95% CI, 0.81-1.15); coronary artery disease (HRadj 1.02; 95% CI, 0.87-1.19); or CVD mortality (HRadj 0.94; 95% CI, 0.71-1.25).

However, the follow-up data did suggest that both composite and individual CVD outcomes were impacted by increased frequency and severity of AECOPD and breathlessness.

“This suggests that other markers of disease severity, rather than rate of lung function decline, might be more closely related to CVD outcomes and mortality,” explained the researchers. “This observation is in keeping with previous observational studies which have demonstrated that the period immediately following an AECOPD are extremely high risk for CVD events such as myocardial infraction and stroke relative to periods of more stable disease.”

Other characteristics like being older, being male, being a smoker, having hypotension, and using statins were also linked with an increased likelihood of CVD events.

Reference

Whittaker HR, Bloom C, Morgan A, Jarvis D, Kiddle SJ, Quint JK. Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients. Eur Respir J. Published online September 24, 2020. doi: 10.1183/13993003.00918-2020.