Respiratory Section, Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
BMJ Open Respir Res. 2020 Feb;7(1). doi: 10.1136/bmjresp-2019-000470.
We investigated risk of coronary heart disease and heart failure in phenotypes of obstructive airway disease.
Among 91 692 participants in the Copenhagen General Population Study, 42 058 individuals were classified with no respiratory disease, and 11 988 individuals had different phenotypes of obstructive airways disease: asthma with early onset or late-onset, chronic obstructive pulmonary disease (COPD) with forced expiratory volume in one second (FEV) above or below 50% of predicted value (%p) or asthma-COPD overlap (ACO).
During a mean follow-up of 5.7 years we registered 3584 admissions for coronary heart disease and 1590 admissions for heart failure. Multivariable Cox regression analyses of time to first admission were used with a two-sided p value of 0.05 as significance level. Compared with no respiratory disease the highest risks of coronary heart disease and heart failure were observed in ACO with late-onset asthma and FEV <50% p, HR=2.2 (95% CI 1.6 to 3.0), and HR=2.9 (95% CI 2.0 to 4.3), respectively. In COPD with FEV above 50% p the HRs were 1.3 (95% CI 1.2 to 1.5) for coronary heart disease and 1.9 (95% CI 1.6 to 2.3) for heart failure. Asthma associated with increased risks of coronary heart disease and heart failure, however, in asthma without allergy the HR was 1.1 (95% CI 0.7 to 1.6) for coronary heart disease while individuals with allergy had an HR of 1.4 (95% CI 1.1 to 1.6).
Risks of coronary heart disease and heart failure were increased in asthma, COPD and ACO. In asthma, the risk of coronary heart disease depended on presence of allergy. We suggest that cardiovascular risk factors should be assessed systematically in individuals with obstructive airway disease with the potential to facilitate targeted treatments.
我们研究了阻塞性气道疾病表型与冠心病和心力衰竭的风险关系。
在哥本哈根普通人群研究的 91692 名参与者中，42058 人被归类为无呼吸道疾病，11988 人患有不同表型的阻塞性气道疾病：早发性或晚发性哮喘、一秒钟用力呼气量（FEV）高于或低于预计值（%p）的慢性阻塞性肺疾病（COPD）或哮喘-COPD 重叠（ACO）。
在平均 5.7 年的随访期间，我们记录了 3584 例冠心病入院和 1590 例心力衰竭入院。使用双侧 p 值为 0.05 的多变量 Cox 回归分析时间至首次入院。与无呼吸道疾病相比，晚发性哮喘和 FEV <50%p 的 ACO 患者冠心病和心力衰竭的风险最高，HR=2.2（95%CI 1.6 至 3.0）和 HR=2.9（95%CI 2.0 至 4.3）。FEV 高于 50%p 的 COPD 患者冠心病的 HRs 为 1.3（95%CI 1.2 至 1.5），心力衰竭的 HRs 为 1.9（95%CI 1.6 至 2.3）。然而，与哮喘相关的冠心病和心力衰竭风险增加，但在无过敏的哮喘患者中，冠心病的 HR 为 1.1（95%CI 0.7 至 1.6），而过敏患者的 HR 为 1.4（95%CI 1.1 至 1.6）。
冠心病和心力衰竭的风险在哮喘、COPD 和 ACO 中增加。在哮喘中，冠心病的风险取决于是否存在过敏。我们建议，应系统地评估阻塞性气道疾病患者的心血管危险因素，以便有可能进行针对性治疗。
