慢性阻塞性肺疾病在缺血性心脏病患者中的患病率和影响：一项纳入 1800 万患者的系统评价和荟萃分析。

Prevalence and Impact of Chronic Obstructive Pulmonary Disease in Ischemic Heart Disease: A Systematic Review and Meta-Analysis of 18 Million Patients.

机构信息

Capital Medical University, Beijing, 100069, People's Republic of China.

National Center for Respiratory Medicine, Beijing, 100029, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2024 Oct 22;19:2333-2345. doi: 10.2147/COPD.S474223. eCollection 2024.

DOI:10.2147/COPD.S474223

PMID:39465033

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11512537/

Abstract

BACKGROUND

The prevalence of chronic obstructive pulmonary disease (COPD) in patients with ischemic heart disease (IHD) remains uncertain, and its association with adverse outcomes is frequently overlooked. This study aimed to estimate the prevalence of COPD, and its impact on pharmacological treatment, and clinical outcomes in patients with IHD.

METHODS

A systematic literature search was conducted in Web of Science, Embase, and PubMed until November 20, 2023. All studies that reported the prevalence of COPD in IHD patients were included, and a random-effects model was employed to calculate the pooled prevalence. Data on cardiovascular risk factors/comorbidities, beta-blockers (BBs) prescription, acute phase outcomes [in-hospital mortality, major adverse cardiovascular events (MACE), acute heart failure (AHF), and cardiogenic shock], and long-term mortality were compared according to COPD status.

RESULTS

A total of 82 eligible studies that reported the prevalence of COPD in 18 million IHD patients were included. The pooled prevalence of COPD was 12.0% [95% confidence intervals (CI): 9.9%-14.1%] in patients with IHD. In subgroup analysis, the prevalence of COPD was highest in North America (15.3%), followed by Europe (10.0%), and Asia (8.8%). In addition, COPD was associated with a higher burden of cardiovascular risk factors/comorbidities, but lower BBs prescription [odds ratio (OR) 0.50, 95% CI 0.38-0.66]. Moreover, COPD was linked to an increased risk of in-hospital mortality (OR 1.47, 95% CI 1.37-1.58), MACE (OR 1.81, 95% CI 1.44-2.27), AHF (OR 2.14, 95% CI 1.86-2.46), cardiogenic shock (OR 1.30, 95% CI 1.01-1.68), as well as long-term mortality (OR 1.99, 95% CI 1.80-2.20).

CONCLUSION

This meta-analysis demonstrated that COPD is prevalent in IHD, involving 12.0% of IHD patients, and is linked to a lower prescription of BBs, an increased burden of comorbidities, and worse acute phase outcomes and long-term mortality.

摘要

背景

慢性阻塞性肺疾病（COPD）在缺血性心脏病（IHD）患者中的患病率仍不确定，其与不良结局的关系经常被忽视。本研究旨在评估 COPD 在 IHD 患者中的患病率，及其对药物治疗和临床结局的影响。

方法

系统检索了 Web of Science、Embase 和 PubMed 中的文献，检索时间截至 2023 年 11 月 20 日。纳入所有报告 IHD 患者 COPD 患病率的研究，并采用随机效应模型计算汇总患病率。根据 COPD 状况比较了心血管危险因素/合并症、β受体阻滞剂（BBs）处方、急性期结局（住院内死亡率、主要心血管不良事件（MACE）、急性心力衰竭（AHF）和心源性休克）以及长期死亡率的数据。

结果

共纳入 82 项符合条件的研究，这些研究报告了 1800 万例 IHD 患者中 COPD 的患病率。IHD 患者中 COPD 的汇总患病率为 12.0%（95%置信区间[CI]：9.9%-14.1%）。亚组分析显示，北美的 COPD 患病率最高（15.3%），其次是欧洲（10.0%）和亚洲（8.8%）。此外，COPD 与心血管危险因素/合并症负担较高相关，但 BBs 处方较低[比值比（OR）0.50，95%CI 0.38-0.66]。此外，COPD 与住院内死亡率（OR 1.47，95%CI 1.37-1.58）、MACE（OR 1.81，95%CI 1.44-2.27）、AHF（OR 2.14，95%CI 1.86-2.46）、心源性休克（OR 1.30，95%CI 1.01-1.68）以及长期死亡率（OR 1.99，95%CI 1.80-2.20）风险增加相关。