• Oskar Wallström, Caroline Stridsman, Anne Lindberg, Fredrik Nyberg, and VanfleterenLowie E G WLEGWCOPD Center, Dept of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenbur.
• COPD Center, Dept of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
• Chest. 2024 Jul 31.

BackgroundAcute exacerbations of COPD (AECOPDs) are increasingly recognized as episodes of heightened risk of cardiovascular events. It is not known whether exacerbation history is differentially associated with future myocardial infarction (MI) or pulmonary embolism (PE).Research QuestionIs the number and severity of AECOPDs associated with increased risk of MI or PE in a real-life cohort of patients with COPD?Study Design And MethodsWe identified a cohort of 66422 patients (≥30yr) with a primary diagnosis of COPD in the Swedish National Airway Register January 2014 to June 2022, with complete data on lung function. Patients were classified by moderate (prescription of oral corticosteroids) and severe (hospitalization) exacerbations the year before index date and were followed until Dec 2022 for hospitalization or death from MI or PE, corresponding to >265 000 patient-years, with a maximum follow-up time of 9 years. Competing-risk regression, according to Fine-Gray, was used to calculate subdistribution hazard ratios (SHRs) with 95% confidence intervals (CI).ResultsCompared with no AECOPDs in the baseline period, AECOPD number and severity was associated with increased long term risk of both MI and PE in a gradual fashion, ranging from a SHR of 1.10 (0.97-1.24) and 1.33 (1.11-1.60), respectively, for one moderate exacerbation, to 1.82 (1.36-2.44) and 2.62 (1.77-3.89), respectively, for two or more severe exacerbations. In a time-restricted follow-up sensitivity analysis, the associations were stronger during the first year of follow up and diminished over time.InterpretationThe risk of MI and PE increases with the frequency and severity of AECOPD in this large real life cohort of patients with COPD.Copyright © 2024. Published by Elsevier Inc.

6 keywords...

hide…