Hawkins Nathaniel M, Nordon Clementine, Rhodes Kirsty, Talukdar Manisha, McMullen Suzanne, Ekwaru Paul, Pham Tram, Randhawa Arsh K, Sin Don D
Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
AstraZeneca UK Limited, Cambridge, UK.
Heart. 2024 Apr 25;110(10):702-709. doi: 10.1136/heartjnl-2023-323487.
To examine the risk of adverse cardiovascular (CV) events following an exacerbation of chronic obstructive pulmonary disease (COPD).
This retrospective cohort study identified patients with COPD using administrative data from Alberta, Canada from 2014 to 2019. Exposure periods were 12 months following moderate or severe exacerbations; the reference period was time preceding a first exacerbation. The primary outcome was the composite of all-cause death or a first hospitalisation for acute coronary syndrome, heart failure (HF), arrhythmia or cerebral ischaemia. Time-dependent Cox regression models estimated covariate-adjusted risks associated with six exposure subperiods following exacerbation.
Among 1 42 787 patients (mean age 68.1 years and 51.7% men) 61 981 (43.4%) experienced at least one exacerbation and 34 068 (23.9%) died during median follow-up of 64 months. The primary outcome occurred in 43 564 (30.5%) patients with an incidence rate prior to exacerbation of 5.43 (95% CI 5.36 to 5.50) per 100 person-years. This increased to 95.61 per 100 person-years in the 1-7 days postexacerbation (adjusted HR 15.86, 95% CI 15.17 to 16.58) and remained increased for up to 1 year. The risk of both the composite and individual CV events was increased following either a moderate or a severe exacerbation, though greater and more prolonged following severe exacerbation. The highest magnitude of increased risk was observed for HF decompensation (1-7 days, HR 72.34, 95% CI 64.43 to 81.22).
Moderate and severe COPD exacerbations are independent risk factors for adverse CV events, especially HF decompensation. The impact of optimising COPD management on CV outcomes should be evaluated.
研究慢性阻塞性肺疾病（COPD）急性加重后发生不良心血管（CV）事件的风险。
这项回顾性队列研究利用加拿大艾伯塔省2014年至2019年的管理数据确定COPD患者。暴露期为中度或重度急性加重后的12个月；参照期为首次急性加重前的时间。主要结局是全因死亡或首次因急性冠状动脉综合征、心力衰竭（HF）、心律失常或脑缺血住院的复合结局。时间依赖性Cox回归模型估计了与急性加重后六个暴露亚期相关的协变量调整风险。
在142787例患者（平均年龄68.1岁，男性占51.7%）中，61981例（43.4%）经历了至少一次急性加重，在64个月的中位随访期内，34068例（23.9%）死亡。主要结局发生在43564例（30.5%）患者中，急性加重前的发病率为每100人年5.43（95%CI 5.36至5.50）。在急性加重后的1 - 7天内，这一发病率增加到每100人年95.61（调整后的HR 15.86，95%CI 15.17至16.58），并在长达1年内持续增加。中度或重度急性加重后，复合CV事件和个体CV事件的风险均增加，尽管重度急性加重后的风险更高且持续时间更长。HF失代偿的风险增加幅度最大（1 - 7天，HR 72.34，95%CI 64.43至81.22）。
中度和重度COPD急性加重是不良CV事件的独立危险因素，尤其是HF失代偿。应评估优化COPD管理对CV结局的影响。
