Nordon Clementine, Simons Sami O, Marshall Jonathan, Müllerová Hana, Pollack Michael, Bengtsson Camilla, Hoti Fabian, Lobier Muriel, Salosensaari Aaro, Santos Ana Cristina, Vogelmeier Claus Franz, Rhodes Kirsty
Biopharmaceuticals Medical, AstraZeneca, Cambridge, UK.
Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.
ERJ Open Res. 2025 Jun 16;11(3). doi: 10.1183/23120541.01091-2024. eCollection 2025 May.
The EXAcerbations of COPD and their OutcomeS on CardioVascular disease (EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, but with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalisability and improve precision.
Studies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with a COPD diagnosis in 2014-2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled hazard ratios (HR) of risks in post-exacerbation periods ( periods outside exacerbations) were obtained through random effects meta-analysis.
Time periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HR 10.22 (95% CI 5.34-19.57) in days 1-7 and HR 1.24 (95% CI 1.09-1.40) in days 181-365. Risks were elevated for 6 months (HR 1.25, 95% CI 1.01-1.55 in days 31-180) and 1 year (HR 1.48, 95% CI 1.11-1.96 in days 181-365) following a moderate or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31-180: HR 1.66 (95% CI 1.14-2.42) and HR 1.61 (95% CI 1.28-2.02) following the first and the second post-diagnosis exacerbation, respectively.
Risk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.
慢性阻塞性肺疾病急性加重及其对心血管疾病的影响（EXACOS-CV）多数据库研究一致表明，慢性阻塞性肺疾病急性加重后严重心血管事件的风险增加，但风险的时间性存在一些差异。对EXACOS-CV研究结果进行荟萃分析，以提高其普遍性并提高精确度。
对在加拿大、美国、德国、荷兰、西班牙、意大利、日本和英国开展的研究进行荟萃分析，涉及1030875名个体。一般来说，每项研究纳入了2014 - 2019年年龄≥40岁且诊断为慢性阻塞性肺疾病的个体；主要结局是非致命性急性冠状动脉综合征、失代偿性心力衰竭、缺血性中风、心律失常和全因死亡的复合结局。通过随机效应荟萃分析得出急性加重期后（非急性加重期）风险的合并风险比（HR）。
任何严重程度的急性加重后的时间段都与复合结局风险的增加和持续相关：第1 - 7天HR为10.22（95%CI 5.34 - 19.57），第181 - 365天HR为1.24（95%CI 1.09 - 1.40）。中度或重度急性加重后6个月（第31 - 180天HR为1.25，95%CI 1.01 - 1.55）和1年（第181 - 365天HR为1.48，95%CI 1.11 - 1.96）风险升高。在新诊断的个体中，风险在第31 - 180天之前增加：首次诊断后急性加重和第二次诊断后急性加重后的HR分别为1.66（95%CI 1.14 - 2.42）和1.61（95%CI 1.28 - 2.02）。
慢性阻塞性肺疾病急性加重后，即使是早期和中度急性加重，严重心血管事件的风险也会持续增加。降低心肺风险应成为慢性阻塞性肺疾病管理的全球核心目标。
