Major cardiovascular risk factors common yet undertreated in patients with COPD

Among patients with COPD, major cardiovascular risk factors were common but inadequately monitored, treated and controlled, researchers reported in the Annals of the American Thoracic Society.

“COPD inherently conveys high cardiovascular risk due to cumulative smoking burden, advanced population age and clustering of additional risk factors, intertwined with socioeconomic deprivation, impaired health literacy and reduced physical activity,” Nathaniel M. Hawkins, MD, MPH, assistant professor in the division of cardiology at the University of British Columbia, Vancouver, and colleagues wrote. “Risk factors were very common in our cohort, with one-quarter having diabetes, > 50% hypertension, > 60% dyslipidemia, > 70% overweight and > 80% smoking history.”

The cross-sectional analysis evaluated medical records of 32,695 patients with COPD (mean age, 68.4 years; 50.7% women) in the Canadian Primary Care Sentinel Surveillance Network from 2013 to 2018. These patients were matched for age, sex and rural residence with 32,638 control participants (mean age, 68.4 years; 50.7% women). Researchers identified five CV risk factors in the cohort: hypertension, dyslipidemia, diabetes, obesity and smoking.

The mean Framingham Risk Score was 20.6% among patients with COPD compared with 18.6% among controls.

Nearly 54% of patients with COPD were categorized as having high CV risk. All five CVD risk factors were more common among patients with COPD compared with controls:

• hypertension (52.3% vs. 44.9%);
• dyslipidemia (62% vs. 57.8%);
• diabetes (25% vs. 20.2%);
• obesity (40.8% vs. 36.8%); and
• smoking (40.9% vs. 11.4%).

According to the researchers, risk factor monitoring among patients with COPD in the previous year was suboptimal, at 71.8% for hypertension, 39.4% for dyslipidemia, 74.5% for diabetes and 52.3% for obesity. Further, smoking status was infrequently reported in electronic medical records. Among monitored patients, guideline-recommended targets were achieved in 60.8% of patients for hypertension, 46.6% for dyslipidemia, 57.4% for diabetes, 10.6% for obesity and 12% for smoking.

In addition, CV therapies were underutilized in patients with COPD. Angiotensin-converting enzyme inhibitors were used in 69%, statins in 69% and smoking-cessation therapies in 27%.

“Strategies are needed to improve risk factor control and increase uptake of simple, affordable cardiovascular therapies to reduce morbidity and mortality in this high-risk group of patients,” the researchers wrote.