ICES, Toronto, ON, Canada.
Centre for Heart Lung Innovation, St Paul's Hospital and Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
Eur Respir J. 2023 Aug 31;62(2). doi: 10.1183/13993003.02364-2022. Print 2023 Aug.
Despite COPD being a risk factor for cardiovascular disease (CVD) and knowing that risk stratification for CVD primary prevention is important, little is known about the real-world risk of CVD among people with COPD with no history of CVD. This knowledge would inform CVD management for people with COPD. The current study aimed to examine the risk of major adverse cardiovascular events (MACE) (including acute myocardial infarction, stroke or cardiovascular death) in a large, complete real-world population with COPD without previous CVD.
We conducted a retrospective population cohort study using health administrative, medication, laboratory, electronic medical record and other data from Ontario, Canada. People without a history of CVD with and without physician-diagnosed COPD were followed between 2008 and 2016, and cardiac risk factors and comorbidities compared. Sequential cause-specific hazard models adjusting for these factors determined the risk of MACE in people with COPD.
Among ∼5.8 million individuals in Ontario aged ≥40 years without CVD, 152 125 had COPD. After adjustment for cardiovascular risk factors, comorbidities and other variables, the rate of MACE was 25% higher in persons with COPD compared with those without COPD (hazard ratio 1.25, 95% CI 1.23-1.27).
In a large real-world population without CVD, people with physician-diagnosed COPD were 25% more likely to have a major CVD event, after adjustment for CVD risk and other factors. This rate is comparable to the rate in people with diabetes and calls for more aggressive CVD primary prevention in the COPD population.
尽管 COPD 是心血管疾病 (CVD) 的一个危险因素，并且知道 CVD 一级预防的风险分层很重要，但对于没有 CVD 病史的 COPD 患者，他们在现实世界中 CVD 的真实风险知之甚少。这些知识将为 COPD 患者的 CVD 管理提供信息。本研究旨在检查在一个没有 CVD 病史的大型、完整的 COPD 真实人群中，主要不良心血管事件 (MACE)（包括急性心肌梗死、中风或心血管死亡）的风险。
我们使用来自加拿大安大略省的健康行政、药物、实验室、电子病历和其他数据进行了一项回顾性人群队列研究。在 2008 年至 2016 年间，对没有 CVD 病史和有医生诊断的 COPD 的患者进行随访，并比较了心脏危险因素和合并症。通过调整这些因素的序贯特异性危害模型，确定了 COPD 患者的 MACE 风险。
在安大略省年龄≥40 岁且没有 CVD 的约 580 万人中，有 152125 人患有 COPD。在调整了心血管危险因素、合并症和其他变量后，与没有 COPD 的患者相比，有 COPD 的患者发生 MACE 的风险高出 25%（危险比 1.25，95%CI 1.23-1.27）。
在一个没有 CVD 的大型真实人群中，在调整了 CVD 风险和其他因素后，经医生诊断患有 COPD 的患者发生重大 CVD 事件的可能性增加了 25%。这一比率与糖尿病患者的比率相当，呼吁在 COPD 人群中更积极地进行 CVD 一级预防。
