COPD patients at increased risk of CVD

Patients with chronic obstructive pulmonary disease (COPD), especially those with concurrent chronic bronchitis and emphysema phenotypes, are prone to the development of cardiovascular disease (CVD), a recent study has shown.

“COPD is the third leading cause of death worldwide and its prevalence is expected to increase,” the researchers said. “Among the many comorbidities frequently experienced by this population, cardiovascular disease exerts a significant impact on individuals with COPD.”

A total of 31,560 adults from the National Health and Nutrition Examination Survey (1999–2018) provided data for this study. Of these, 2,504 had COPD. [Respirology 2024;29:1047-1057]

The risk of CVD, including coronary heart disease, heart failure, myocardial infarction, and stroke, was significantly elevated in patients with COPD regardless of phenotype. Specifically, those with chronic bronchitis (odds ratio [OR], 1.76, 95 percent confidence interval [CI], 1.41–2.20) and emphysema (OR, 2.31, 95 percent CI, 1.80–2.96) were more likely to report CVDs.

Of note, patients with a concurrent phenotype or combined chronic bronchitis and emphysema showed the highest odds of developing CVD (OR, 2.98, 95 percent CI, 2.11–4.21).

“Our data confirms that patients with COPD present an elevated risk of developing CVD among all phenotypes, with the most marked increase being in those with concurrent chronic bronchitis and emphysema phenotypes,” the researchers said. 

“These findings emphasize the need for frequent cardiovascular screening in individuals with COPD similar to that of established lung cancer screening practices with an emphasis on individuals with emphysema or concurrent phenotypes,” they added.

Mechanistic link

An earlier study reported a 25-percent higher likelihood of developing a major cardiovascular event in people with COPD relative to those without. The present study supported this finding, with CVD prevalence in COPD ranging from 18 percent to 38 percent depending on disease phenotype. [Eur Respir J 2023;62:2202364]

Previous studies also tried to explain the association of CVD with COPD, with some pointing to ageing and smoking as shared risk factors. Others, however, suggested a more mechanistic link between comorbidities such as oxidative stress, inflammation, endothelial dysfunction, and accelerated ageing. [J Thorac Dis 2016;8:E31-E40; Health Sci Rep 2022;5:e586; J Thorac Dis 2020;12:3866-3876]

“Results from the present study support the latter hypothesis since a relationship between COPD and CVD risk is still present when controlling for common demographics and frequent risk factors, including ageing and smoking status,” the researchers said. 

“However, the exact nature of the mechanistic links between these two conditions remains unclear. Additional research is warranted to elucidate potential causal factors and associations,” they added. 

A highly prevalent disease, COPD usually occurs with other comorbidities, with a diverse range of cardiovascular conditions seen in those with this respiratory condition. Such events may contribute to mortality. [Ther Adv Respir Dis 2018;12:1753465817750524; BMJ 2000;320:1297-1303; N Engl J Med 2007;356:775-789; Am J Respir Crit Care Med 2009;180:948-955]