Division of Pulmonary, Allergy, and Critical Care Medicine.
Duke Clinical Research Institute, Durham, North Carolina; and.
Ann Am Thorac Soc. 2024 Nov;21(11):1516-1523. doi: 10.1513/AnnalsATS.202401-017OC.
Meta-analyses have suggested the risk of cardiovascular disease (CVD) events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation. However, many of these studies have included a broad array of CVD events or have been limited to highly selected patient populations potentially not generalizable to the broader population of COPD. We assessed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and identified patient factors associated with ASCVD hospitalizations after COPD hospitalization. This retrospective cohort study used claims data from 920,550 Medicare beneficiaries hospitalized for COPD from 2016 to 2019 in the United States. The primary outcome was risk of an ASCVD hospitalization composite outcome (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, stroke, or transient ischemic attack) in the 30 days and 1 year after COPD hospitalization relative to the same time period before COPD hospitalization. Time in the before and after COPD hospitalization time periods to a composite ASCVD hospitalization outcome were modeled using an extension of the Cox proportional hazards model, the Anderson-Gill model, with adjustment for patient characteristics. Additional analyses evaluated for interactions in subgroups associated with the composite ASCVD hospitalization outcome. Among 920,550 patients in the 30-day and 1-year cohorts (mean age, 73-74 yr) the hazard ratio estimate (95% confidence interval) for the composite ASCVD hospitalization outcome after COPD hospitalization versus before COPD hospitalization for the 30-day cohort was 0.99 (0.93, 1.05; = 0.67), and for the 1-year cohort, it was 0.99 (0.97, 1.02; = 0.53) after adjustment. We observed three subgroups that were significantly associated with higher risk for ASCVD hospitalizations 1 year after COPD hospitalization: 76+ years old, women, and COPD hospitalization severity. Among Medicare beneficiaries hospitalized for COPD, the risk of ASCVD hospitalization was not significantly increased 30 days or 1 year after COPD hospitalization relative to before COPD hospitalization. In subgroup analyses, we identified age 76+ years old, female sex, and COPD hospitalization severity as high-risk subgroups with increased risk of ASCVD events 1 year after COPD hospitalization. Further research is needed to characterize the COPD exacerbation populations at highest ASCVD hospitalization risk.
荟萃分析表明，慢性阻塞性肺疾病（COPD）加重后发生心血管疾病（CVD）事件的风险显著增加。然而，这些研究中的许多都包含了广泛的 CVD 事件，或者仅限于高度选择的患者群体，这些患者群体可能不具有普遍性。我们评估了与 COPD 住院前相比，COPD 住院后发生动脉粥样硬化性心血管疾病（ASCVD）住院的风险，并确定了与 COPD 住院后发生 ASCVD 住院相关的患者因素。这项回顾性队列研究使用了来自美国 2016 年至 2019 年因 COPD 住院的 920,550 名 Medicare 受益人的索赔数据。主要结局是与 COPD 住院前相同时间段相比，COPD 住院后 30 天和 1 年内 ASCVD 住院复合结局（心肌梗死、经皮冠状动脉介入治疗、冠状动脉旁路移植术、卒中和短暂性脑缺血发作）的风险。使用 Cox 比例风险模型的扩展模型（Anderson-Gill 模型）对 COPD 住院前后时间段内的复合 ASCVD 住院结局进行建模，调整了患者特征。额外的分析评估了与复合 ASCVD 住院结局相关的亚组中的交互作用。在 30 天和 1 年队列的 920,550 名患者中（平均年龄 73-74 岁），与 COPD 住院前相比，COPD 住院后 30 天队列中 ASCVD 住院复合结局的风险比估计值（95%置信区间）为 0.99（0.93，1.05；=0.67），1 年队列中为 0.99（0.97，1.02；=0.53）。调整后，我们观察到三个亚组与 COPD 住院后 1 年 ASCVD 住院风险显著相关：76 岁以上、女性和 COPD 住院严重程度。在 Medicare 受益人群中，与 COPD 住院前相比，COPD 住院后 30 天或 1 年发生 ASCVD 住院的风险无显著增加。在亚组分析中，我们发现 76 岁以上、女性和 COPD 住院严重程度是 COPD 住院后 1 年 ASCVD 事件风险增加的高危亚组。需要进一步研究以确定 ASCVD 住院风险最高的 COPD 加重人群。
