PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
IQVIA, Real World Solutions, Solna, Sweden.
Respir Res. 2023 Nov 21;24(1):293. doi: 10.1186/s12931-023-02601-4.
People living with chronic obstructive pulmonary disease (COPD) have an increased risk of experiencing cardiovascular (CV) events, particularly after an exacerbation. Such CV burden is not yet known for incident COPD patients. We examined the risk of severe CV events in incident COPD patients in periods following either moderate and/or severe exacerbations.
Persons aged ≥ 40 years with an incident COPD diagnosis from the PHARMO Data Network were included. Exposed time periods included 1-7, 8-14, 15-30, 31-180 and 181-365 days following an exacerbation. Moderate exacerbations were defined as those managed in outpatient settings; severe exacerbations as those requiring hospitalisation. The outcome was a composite of time to first severe CV event (acute coronary syndrome, heart failure decompensation, cerebral ischaemia, or arrhythmia) or death. Hazard ratios (HR) were estimated for association between each exposed period and outcome.
8020 patients with newly diagnosed COPD were identified. 2234 patients (28%) had ≥ 1 exacerbation, 631 patients (8%) had a non-fatal CV event, and 461 patients (5%) died during a median follow-up of 36 months. The risk of experiencing the composite outcome was increased following a moderate/severe exacerbation as compared to time periods of stable disease [range of HR: from 15.3 (95% confidence interval 11.8-20.0) in days 1-7 to 1.3 (1.0-1.8) in days 181-365]. After a moderate exacerbation, the risk was increased over the first 180 days [HR 2.5 (1.3-4.8) in days 1-7 to 1.6 (1.3-2.1) in days 31-180]. After a severe exacerbation, the risk increased substantially and remained higher over the year following the exacerbation [HR 48.6 (36.9-64.0) in days 1-7 down to 1.6 (1.0-2.6) in days 181-365]. Increase in risk concerned all categories of severe CV events.
Among incident COPD patients, we observed a substantial risk increase of severe CV events or all-cause death following either a moderate or severe exacerbation of COPD. Increase in risk was highest in the initial period following an exacerbation. These findings highlight the significant cardiopulmonary burden among people living with COPD even with a new diagnosis.
患有慢性阻塞性肺疾病（COPD）的人发生心血管（CV）事件的风险增加，尤其是在加重后。对于新诊断的 COPD 患者，尚不清楚这种 CV 负担的情况。我们检查了在中度和/或重度加重后，新诊断 COPD 患者发生严重 CV 事件的风险。
从 PHARMO 数据网络中纳入年龄≥40 岁的新发 COPD 患者。暴露时间包括加重后 1-7、8-14、15-30、31-180 和 181-365 天。中度加重定义为在门诊治疗的患者；重度加重为需要住院治疗的患者。主要结局为首次严重 CV 事件（急性冠状动脉综合征、心力衰竭失代偿、脑缺血或心律失常）或死亡的复合终点。使用风险比（HR）估计每个暴露期与结局之间的关联。
共纳入 8020 名新诊断的 COPD 患者。2234 名患者（28%）有≥1 次加重，631 名患者（8%）发生非致命性 CV 事件，461 名患者（5%）在中位 36 个月的随访期间死亡。与疾病稳定期相比，中度/重度加重后发生复合结局的风险增加[风险比范围：1-7 天为 15.3（95%置信区间 11.8-20.0），181-365 天为 1.3（1.0-1.8）]。中度加重后，前 180 天的风险增加[1-7 天为 2.5（1.3-4.8），31-180 天为 1.6（1.3-2.1）]。重度加重后，风险显著增加，并在加重后一年仍保持较高水平[1-7 天为 48.6（36.9-64.0），181-365 天为 1.6（1.0-2.6）]。风险增加涉及所有严重 CV 事件类别。
在新诊断的 COPD 患者中，我们观察到中度或重度 COPD 加重后严重 CV 事件或全因死亡的风险显著增加。加重后最初时期的风险增加最高。这些发现强调了即使是新诊断的 COPD 患者，也存在显著的心肺负担。
