Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil.
Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil.
Int J Chron Obstruct Pulmon Dis. 2023 Aug 29;18:1899-1908. doi: 10.2147/COPD.S410416. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD.
This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test.
COPD patients were older (=0.028), had a greater frequency of diabetes (=0.026), were more likely to be smokers (<0.001), and had higher modified Medical Research Council scores (<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all <0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; <0.0001).
COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.
慢性阻塞性肺疾病（COPD）会使冠心病（CAD）患者的预后恶化。然而，稳定或症状轻微的 COPD 患者的心血管预后尚不清楚。在这里，我们旨在确定伴有亚临床或早期 COPD 的 CAD 患者的长期心血管事件。
这是一项纵向分析研究，涉及 117 例疑似或确诊 CAD 的患者，这些患者接受了肺功能评估（通过肺活量测定法），并随访了六年（2015 年 3 月至 2021 年 1 月）。患者被分为两组，一组为 COPD（n=44）患者，另一组为非 COPD（n=73）患者。使用 Cox 回归来评估 COPD 与心血管事件之间的关联，同时调整了已确立的 CAD 危险因素，并使用 Cohen 检验来衡量效应大小。
COPD 患者年龄更大（=0.028），糖尿病发病率更高（=0.026），更有可能是吸烟者（<0.001），且改良的医学研究理事会评分更高（<0.001）。两组间在性别、体重指数、高血压、血脂异常、CAD 家族史和心绞痛类型方面无差异。COPD 组 CAD 的发生频率以及严重和多支血管 CAD 的患者比例均显著高于非 COPD 组（均<0.001）。在六年的随访中，COPD 患者发生不良心血管事件的可能性大于非 COPD 患者（<0.001；效应大小，0.720）。在调整了已确立的 CAD 危险因素后，COPD 的发生仍然是长期不良心血管事件的独立预测因素（OR：5.13；95%CI：2.29-11.50；<0.0001）。
在疑似或确诊 CAD 的患者中，COPD 与冠状动脉病变严重程度增加以及更多不良心血管事件相关。在伴有亚临床或早期 COPD 的稳定患者中，COPD 仍然是长期心血管事件的预测因素，独立于已确立的 CAD 危险因素。
