Hamada Kazuki, Oishi Keiji, Yamamoto Tasuku, Murata Yoriyuki, Asami-Noyama Maki, Edakuni Nobutaka, Hirano Tsunahiko, Abe Takeshi, Nakatsui Masahiko, Asai Yoshiyuki, Matsunaga Kazuto
Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
AI Systems Medicine Research and Training Center, Graduate School of Medicine, Yamaguchi University and Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Int J Chron Obstruct Pulmon Dis. 2025 Sep 4;20:3111-3122. doi: 10.2147/COPD.S538054. eCollection 2025.
Chronic obstructive pulmonary disease (COPD) is associated with frailty and leads to poor outcomes. The relationship between COPD and cardiovascular events is well established. However, the impact of frailty on cardiovascular events in COPD patients remains unknown. We aimed to evaluate the long-term association between frailty, assessed using the hospital frailty risk score (HFRS), and major adverse cardiovascular events (MACE) in COPD patients.
We recruited Japanese patients with COPD between 2013 and 2023 from Sado-Himawari Net, a regional electronic health record system in Sado City, Niigata Prefecture, Japan. MACE were defined as a composite of acute coronary syndrome, heart failure, and stroke. We classified the participants into four frailty categories according to HFRS: no-frailty with HFRS=0, low with HFRS >0 and <5, intermediate with HFRS ≥5 and <15, and high with HFRS ≥15. We used a Cox regression model adjusted for age, sex, inhaled treatments, and comorbidities to evaluate the hazard ratio (HR) for MACE.
We recruited 1527 patients with COPD. In multivariable analysis, COPD was associated with MACE as follows: no-frailty versus low HFRS (HR, 1.47 [95% confidence interval, 1.01-2.14], p<0.05), intermediate HFRS (HR 2.00 [1.34-2.97], p<0.001), and high HFRS (HR 2.62 [1.50-4.59], p<0.001). Similar relationships were observed even after adjusting for the severity of airflow limitation and COPD exacerbation.
Frailty was independently associated with MACE in COPD patients during the 10-year follow-up period. Frailty assessment supports the identification of patients with COPD at risk of MACE.
慢性阻塞性肺疾病（COPD）与身体虚弱相关，并导致不良后果。COPD与心血管事件之间的关系已得到充分证实。然而，身体虚弱对COPD患者心血管事件的影响尚不清楚。我们旨在评估使用医院虚弱风险评分（HFRS）评估的身体虚弱与COPD患者主要不良心血管事件（MACE）之间的长期关联。
我们从日本新潟县佐渡市的区域电子健康记录系统佐渡向日葵网络中招募了2013年至2023年期间的日本COPD患者。MACE被定义为急性冠状动脉综合征、心力衰竭和中风的综合。我们根据HFRS将参与者分为四类虚弱：HFRS=0为无虚弱，HFRS>0且<5为低虚弱，HFRS≥5且<15为中度虚弱，HFRS≥15为高虚弱。我们使用调整了年龄、性别、吸入治疗和合并症的Cox回归模型来评估MACE的风险比（HR）。
我们招募了1527例COPD患者。在多变量分析中，COPD与MACE的关联如下：无虚弱与低HFRS（HR，1.47[95%置信区间，1.01-2.14]，p<0.05）、中度HFRS（HR 2.00[1.34-2.97]，p<0.001）和高HFRS（HR 2.62[1.50-4.59]，p<0.001）。即使在调整气流受限严重程度和COPD急性加重后，也观察到了类似的关系。
在10年随访期间，身体虚弱与COPD患者的MACE独立相关。虚弱评估有助于识别有MACE风险的COPD患者。
