Important points:

• The likelihood of cardiovascular disease was increased when spirometry findings were impaired compared to normal.
• People with reduced spirometry and COPD are also at increased risk of developing cardiovascular disease.

Impaired compared to normal spirometry findings and the presence of COPD increase the odds of developing cardiovascular disease and the risk of developing cardiovascular disease, according to research published today. chest.

Jean Bourbeau

“Our findings in the Canadian Obstructive Lung Disease Cohort (CanCOLD) highlight the importance of early detection and diagnosis of COPD for physicians in their daily practice, thereby reducing cardiovascular risk. Evaluation and management should be expanded.” Dr. Jean Bourbeau, Master’s degree, FRCPC,FCAHS, Professor of Medicine at McGill University told Helio.

“The current Global Initiative on Chronic Obstructive Lung Disease (GOLD) report recommends that all patients with COPD be evaluated for cardiovascular disease,” says the McGill University Health Center Research Institute. said Bourbeau, who is also a senior scientist in the Respiratory Disease Translational Research Program at . He continued. “This reinforces why early detection and management of COPD should be a priority.”

In the CanCOLD study, Bourbeau et al. evaluated 1,561 people (mean age 67 years, 56% male, 95% Caucasian) and found 835 with impaired spirometry and 726 with normal spirometry. We investigated how the prevalence and incidence of cardiovascular disease (6.3 years of CVD) vary between the two groups.

The researchers assessed the groups against each other through logistic regression and a Cox model that adjusted for age, gender, smoking status, diabetes, hypertension, low-density lipoprotein, and BMI.

In the cohort of individuals with spirometry impairment, most had COPD GOLD stage 1 disease (n = 408), followed by GOLD stage 2 or higher (n = 331) and maintenance rate spirometry impairment (PRISm). , n = 96).

The researchers further observed a high proportion of undiagnosed COPD in both GOLD stage groups (stage 1, 84%; stage 2 and above, 58%), which could lead to poor outcomes. Bourbeau told Helio.

“Undiagnosed patients may experience respiratory symptoms, exacerbations, and cardiovascular events, and may miss opportunities for early preventive treatment to be considered,” Bourbeau said.

Epidemic of CVD

The researchers included ischemic heart disease (n = 160) and heart failure (n = 27) in their definition of CVD.

Compared with individuals with normal spirometry, those with impaired spirometry had significantly higher odds of CVD (aOR = 1.66; 95% CI, 1.13-2.43).

According to the researchers, the COPD group also had higher adjusted odds of CVD (aOR = 1.55, 95% CI, 1.04-2.31) compared with the normal spirometry group.

Within the spirometry-impaired cohort, CVD prevalence was significantly greater in PRISm patients (aOR = 2.68; 95% CI, 1.35-5.31) and in patients with COPD GOLD stage 2 or higher (aOR = 2.46; 95% CI, 1.57) A significant increase in odds was observed. -3.85) compared to patients with normal spirometry.

The researchers found no statistically significant difference in CVD prevalence between patients with GOLD stage 1 and those with normal spirometry.

CVD incidence

Of the individuals who had no history of heart disease at baseline, 1,054 participated in long-term follow-up. In this population, 453 individuals had normal spirometry findings and 601 individuals had impaired spirometry findings (n = 48 in PRISm, n = 338 in GOLD stage 1, and n = 338 in GOLD stage 2 and above). n = 215).

During an average follow-up period of 5.7 years, the researchers found 48 cases of ischemic heart disease/heart failure.

Similar to the odds of CVD prevalence, both patients with impaired spirometry and patients with COPD faced an increased risk of developing CVD compared to patients with normal spirometry (impaired spirometry, aHR = 2.07; 95% CI, 1.1-3.91; COPD, aHR = 2.09; 95% CI, 1.1-3.98). Of note, this analysis was adjusted for age, gender, smoking status, and diabetes.

“Our study shows that from a population-based sample, the prevalence and incidence of people with mild to moderate COPD, the majority without a previous physician diagnosis of COPD, is between 2 and 3. “We show for the first time that the rate of CVD compared to non-COPD after adjusting for gender, age and smoking is three times higher,” Bourbeau told Healio.

Researchers also found that patients with COPD GOLD stage 2 or higher (HR = 2.78; 95% CI, 1.32-5.84) had a significantly increased risk of CVD compared with patients with normal spirometry. Did. In contrast, the risk of CVD was not statistically significantly different between GOLD stage 1 and normal spirometry findings.

CVD risk score

As an additional analysis, the researchers examined the discrimination for predicting CVD using two CVD risk scores: the pooled cohort equation (PCE) and the Framingham risk score.

According to the researchers, including impaired spirometry findings in these risk scores provides “low and limited” discrimination for predicting CVD.

“The most surprising finding of this study was that the cardiovascular risk score (PCE or Framingham Risk Score) did not improve its ability to predict cardiovascular events in patients with mild to moderate COPD,” Bourbeau said. said the doctor. “Even with the addition of impaired spirometry findings, their assessment was limited. This suggests that current risk scores underestimate the true risk of cardiovascular events in his COPD patients.” suggests.”

Future research

Bourbeau told Helio that it is important that COPD is now recognized as a cardiopulmonary disease.

“We are facing a new paradigm in which COPD is not just a lung disease, but a cardiopulmonary disease,” Bourbeau said. “Research funding for respiratory diseases continues to lag behind funding for other chronic diseases such as diabetes, cardiovascular disease, and cancer. , could create an opportunity for funding bodies to prioritize and fund COPD research at the level needed.”

When asked about future research, Professor Bourbeau said there should be an important focus on cardiovascular risk assessment.

“Cardiovascular risk assessment needs to be improved, as current cardiovascular risk scores do not adequately identify high-risk COPD patients,” Bourbeau told Healio. “This will incorporate information about disease severity beyond findings from impaired spirometry to see if we can improve cardiovascular disease risk prediction in COPD patients compared to standard risk prediction alone. This may be done in future studies, including

“This may help provide an integrated care model that considers both COPD and CVD and target patients to achieve improved outcomes,” Bourbeau added.