Pulmonology Department, Hospital Universitario, Guadalajara, Spain.
Int J Chron Obstruct Pulmon Dis. 2010 Nov 8;5:387-94. doi: 10.2147/copd.s14063.
The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic heart disease and whether this association is related with a greater prevalence of classical cardiovascular risk factors. Ours is a case-control cross-sectional study design. Cases were hospital patients with ischemic heart disease in stable phase, compared with control hospital patients. All patients underwent post-bronchodilator (PBD) spirometry, a standardized questionnaire, and blood analysis. COPD was defined as per GOLD PBD forced expiratory volume in the first second (FEV(1))/forced vital capacity (FVC) < 0.70. In our series of patient cases (n = 204) and controls (n = 100), there were 169 men in the case group (83%) and 84 in the control group (84%). Ages were 67 and 64 years, respectively (P < 0.05). There were no significant differences by weight, body mass index (BMI), pack-years, leukocytes, or homocysteine. The abdominal perimeter was significantly greater in cases (mean 101 cm ± standard deviation [SD] 10 versus 96 cm ± 11; P < 0.000). Both groups also had significant differences by C-reactive protein (CRP), fibrinogen, and hemoglobin values. In univariate analysis, increased risks for cases to show with individual classical cardiovascular risk factors were seen, with odds ratio (OR) 1.86 and 95% confidence interval (CI) (1.04-3.33) for diabetes mellitus, dyslipidemia (OR 2.10, 95% CI: 1.29-3.42), arterial hypertension (OR 2.47, 95% CI: 1.51-4.05), and increased abdominal perimeter (OR 1.71, 95% CI: 1.06-2.78). Percent predicted PBD FEV(1) was 97.6% ± 23% in the patient group and 104% ± 19% in the control group (P = 0.01), but the prevalence of COPD was 24.1% in cases and 21% in controls. Therefore, COPD was not associated with ischemic heart disease: at the crude level (OR 1.19, 95% CI: 0.67-2.13) or after adjustment (OR 1.14, 95% CI:0.57-2.29). In conclusion, COPD was not associated with ischemic heart disease. The greater prevalence of classical cardiovascular risk factors in COPD patients could explain the higher occurrence of ischemic heart disease in these patients.
我们的研究目的是确定慢性阻塞性肺疾病（COPD）是否为缺血性心脏病的独立危险因素，以及这种关联是否与更普遍的经典心血管危险因素有关。我们的研究设计为病例对照的横断面研究。病例为稳定期缺血性心脏病住院患者，与对照组住院患者进行比较。所有患者均进行支气管扩张后（PBD）肺量测定、标准化问卷和血液分析。COPD 按照 GOLD 标准定义为 PBD 第一秒用力呼气量（FEV1）/用力肺活量（FVC）<0.70。在我们的患者病例系列（n=204）和对照组（n=100）中，病例组有 169 名男性（83%），对照组有 84 名（84%）。年龄分别为 67 岁和 64 岁（P<0.05）。体重、体重指数（BMI）、吸烟指数、白细胞或同型半胱氨酸无显著差异。病例组的腹围明显更大（平均值 101cm±标准差[SD]10 与 96cm±11；P<0.000）。两组的 C 反应蛋白（CRP）、纤维蛋白原和血红蛋白值也有显著差异。在单变量分析中，观察到病例组出现个体经典心血管危险因素的风险增加，糖尿病的比值比（OR）为 1.86，95%置信区间（CI）为 1.04-3.33，血脂异常（OR 2.10，95%CI：1.29-3.42），动脉高血压（OR 2.47，95%CI：1.51-4.05）和腹围增加（OR 1.71，95%CI：1.06-2.78）。病例组 PBD FEV1 预测百分比为 97.6%±23%，对照组为 104%±19%（P=0.01），但病例组的 COPD 患病率为 24.1%，对照组为 21%。因此，COPD 与缺血性心脏病无关：在原始水平（OR 1.19，95%CI：0.67-2.13）或调整后（OR 1.14，95%CI：0.57-2.29）。总之，COPD 与缺血性心脏病无关。COPD 患者更普遍存在经典心血管危险因素，可能解释了这些患者中缺血性心脏病的更高发生率。
