Impaired spirometry, COPD raise cardiovascular disease prevalence, incidence
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Key takeaways:
- The likelihood for cardiovascular disease increased with impaired vs. normal spirometry findings.
- Individuals with impaired spirometry and COPD also faced a greater risk for incident cardiovascular disease.
Having impaired vs. normal spirometry findings, as well as COPD, raised the odds for cardiovascular disease and the risk for incident cardiovascular disease, according to study results published in CHEST.
“The results of our study from the Canadian Cohort Obstructive Lung Disease (CanCOLD) emphasize the relevance for the physicians in daily practice of an early detection and diagnosis of COPD, and this should extend assessing and managing cardiovascular risk,” Jean Bourbeau, MD, MSc, FRCPC, FCAHS, professor in the department of medicine at McGill University, told Healio.
“Current Global Initiative for Chronic Obstructive Lung Disease (GOLD) reports recommend assessing all patients with COPD for cardiovascular disease,” Bourbeau, who is also a senior scientist in the translational research in respiratory diseases program at the Research Institute of the McGill University Health Centre, continued. “This adds to the reason that we should be given priority to the early detection and management of COPD.”
In the CanCOLD study, Bourbeau and colleagues assessed 1,561 individuals (mean age, 67 years; 56% men: 95% white) — 835 with impaired spirometry findings and 726 with normal spirometry findings — to see how the prevalence and incidence of cardiovascular disease (CVD) over 6.3 years each differs between the two groups.
Researchers evaluated the groups against one another through logistic regression and Cox models adjusted for age, sex, smoking status, diabetes, hypertension, low-density lipoprotein and BMI.
Within the cohort of individuals with impaired spirometry, most had COPD GOLD stage 1 disease (n = 408), followed by GOLD stage 2 or higher (n = 331) and preserved ratio impaired spirometry (PRISm, n = 96).
Researchers further observed high rates of undiagnosed COPD in both GOLD stage groups (stage 1, 84%; stage 2 or higher, 58%), which could lead to poor outcomes, Bourbeau told Healio.
“There is potential consequence that patients who are undiagnosed may experience respiratory symptoms, exacerbations and cardiovascular events, missing the opportunity of being considered for early preventive treatment,” Bourbeau said.
CVD prevalence
Within the definition of CVD, researchers included ischemic heart disease (n = 160) and heart failure (n = 27).
Compared with individuals with normal spirometry, those with impaired spirometry faced significantly heightened odds for CVD (aOR = 1.66; 95% CI, 1.13-2.43).
The group with COPD also had elevated adjusted odds for CVD (aOR = 1.55; 95% CI, 1.04-2.31) vs. the group with normal spirometry, according to researchers.
Within the impaired spirometry cohort, significantly increased odds for CVD prevalence were found among those with PRISm (aOR = 2.68; 95% CI, 1.35-5.31) and those with COPD GOLD stage 2 or higher (aOR = 2.46; 95% CI, 1.57-3.85) vs. those with normal spirometry.
Between individuals with GOLD stage 1 and individuals with normal spirometry, researchers did not find a statistically significant difference in CVD prevalence.
CVD incidence
Of the individuals who did not have a history of heart disease at baseline, 1,054 participated in longitudinal follow-up. In this population, 453 individuals had normal spirometry findings and 601 individuals had impaired spirometry findings (n = 48 with PRISm; n = 338 with GOLD stage 1; n = 215 with GOLD stage 2 or higher).
Within the mean follow-up period of 5.7 years, researchers found 48 incident cases of ischemic heart disease/heart failure.
Similar to the odds for CVD prevalence, those with impaired spirometry and those with COPD both faced an increased risk for incident CVD vs. those with normal spirometry (impaired spirometry, aHR = 2.07; 95% CI, 1.1-3.91; COPD, aHR = 2.09; 95% CI, 1.1-3.98). Notably, this analysis was adjusted for age, sex, smoking status and diabetes.
“Our study shows for the first time that from a population-based sample, individuals having mild to moderate COPD and for a large proportion not having previously had a physician diagnosis of COPD, had 2-to-3-time fold increased prevalence and incidence of CVDs compared to non-COPD after adjusting for sex, age and smoking,” Bourbeau told Healio.
Researchers further found a significantly increased risk for CVD among those with COPD GOLD stage 2 or higher (HR = 2.78; 95% CI, 1.32-5.84) vs. those with normal spirometry. In contrast, the risk for CVD did not statistically significantly differ between GOLD stage 1 and normal spirometry findings.
CVD risk score
As an additional analysis, researchers looked at the discrimination for predicting CVD using two CVD risk scores: pooled cohort equations (PCE) and the Framingham risk score.
Including impaired spirometry findings in these risk scores yielded “low and limited” discrimination for predicting CVD, according to researchers.
“The most surprising finding of the study was that the cardiovascular risk scores (PCE or Framingham risk score) did not improve in the ability to predict cardiovascular events in individuals with mild to moderate COPD,” Bourbeau said. “Their assessment was limited even when adding impaired spirometry findings. This suggests that the current risk scores underestimate the real risk of cardiovascular events in COPD patients.”
Future research
Moving forward, it is important that COPD is recognized as a cardiopulmonary disease, Bourbeau told Healio.
“We are faced with a new paradigm that COPD is not only a pulmonary disease but a cardiopulmonary disease,” Bourbeau said. “Research fundings in respiratory disease still lag behind the funding for other chronic diseases such as diabetic diseases, cardiovascular diseases and cancer. This new paradigm may create an opportunity for research to involve the collaboration of cardiologists and pulmonologists, and funding organizations to prioritize and provide funding of COPD research at the necessary level.”
When asked about future studies, Bourbeau said that one important focus should be directed on cardiovascular risk assessments.
“Cardiovascular risk assessment needs to be improved as the current cardiovascular risk scores cannot properly identify high-risk COPD individuals,” Bourbeau told Healio. “This could be done in future studies incorporating information on disease severity beyond impaired spirometry findings and including exacerbations to see if we can improve cardiovascular disease risk prediction in COPD patients relative to the standard risk prediction alone.
“This may help to target patients for delivering integrated care models that consider both COPD and CVD, and achieving improved outcome,” Bourbeau added.