COPD exacerbations raise risk for acute cardiovascular events

Key takeaways:

• Experiencing an acute COPD exacerbation raised the risk for acute cardiovascular events, such as a stroke or heart attack.
• In patients with a severe exacerbation, this risk was heightened.

WASHINGTON — Patients who experienced a COPD exacerbation had a greater risk for acute cardiovascular events than patients who did not, according to a presentation at the American Thoracic Society International Conference.

These presented data were part of the retrospective cohort study EXACOS-CV US, which, along with the EROS study, was one of two notable AstraZeneca-funded studies examining COPD presented at ATS 2023.

Charlie Strange

“These results suggest patients with COPD should be considered at risk of cardiopulmonary events, including stroke, heart failure, pulmonary embolism, arrhythmia or heart attack, following an acute exacerbation, even those who are newly diagnosed,” Charlie Strange, MD, professor of pulmonary and critical care medicine at Medical University of South Carolina and investigator in the EROS study, told Healio.

In EXACOS-CV US, Kimberly Daniels, MS, PhD, senior researcher at HealthCore Inc., and colleagues evaluated 355,978 adults from the HealthCore Integrated Research Database to look at the difference in frequency of acute cardiovascular events between those who had an acute COPD exacerbation (n = 145,838; mean age, 63 years) and those who did not have an acute COPD exacerbation.

According to the abstract, several hospitalizations were recognized as acute cardiovascular events, such as acute coronary syndrome, ischemic stroke, acute heart failure, pulmonary embolism, arrhythmia or cardiac arrest.

Researchers assessed both sets of patients with Cox models that took into account demographics, as well as past medical and prescription information.

Of the patients with an acute COPD exacerbation, nearly half (48%) of the cohort had a cardiologist visit at baseline, while only a little more than a quarter (27%) had a pulmonologist visit at this time.

Researchers found that the hazard ratio for an acute cardiovascular event within 30 days of a COPD exacerbation was 1.32 (95% CI, 1.11-1.35), signaling a 32% increased risk for this outcome in patients who experienced an exacerbation compared with patients who did not, according to a press release from AstraZeneca. This risk was also high at 1 year, with day 90 showing the greatest risk.

When evaluating acute COPD exacerbations by severity, researchers observed a greater risk for an acute cardiovascular event outcome in those who experienced a severe exacerbation (30-day HR = 1.85; 95% CI, 1.6-2.14). Patients with a moderate exacerbation also showed a heightened risk for these events (30-day HR = 1.22; 95% CI, 1.11-1.35) compared with those without an exacerbation, although this risk was lower than that observed in those with a severe exacerbation.

Further, the risk for an acute cardiovascular event rose with more COPD exacerbations, with two or three exacerbations raising the risk by more than twofold, according to the release.

When put together with the EROS study, both have important implications for patients with COPD.

“Sometimes clinicians are not as aggressive with COPD care when cardiovascular disease is contributing to dyspnea,” Strange told Healio. “This combination of studies [EXACOS-CV and EROS studies] suggests that the sickest patients should get triple therapy inhalers after exacerbations.”

Reference:

• New AstraZeneca data presented at ATS 2023 strengthen the body of evidence supporting early intervention with BREZTRI in COPD. https://www.astrazeneca-us.com/media/press-releases/2023/new-astrazeneca-data-presented-at-ats-2023-strengthen-the-body-of-evidence-supporting-early-intervention-with-breztri-in-copd.html. Published May 23, 2023. Accessed May 26, 2023.