Chest

Chest

Volume 144, Issue 4, October 2013, Pages 1163-1178
Journal home page for Chest

Original Research
COPD
Cardiovascular Comorbidity in COPD: Systematic Literature Review

https://doi.org/10.1378/chest.12-2847Get rights and content

Background

Cardiovascular disease (CVD) is common among patients with COPD. However, it is not clear whether this is due to shared risk factors or if COPD increases the risk for CVD independently. This study aimed to provide a systematic review of studies that investigated the association between COPD and CVD outcomes, assessing any effect of confounding by common risk factors.

Methods

A search was conducted in MEDLINE (via PubMed) for observational studies published between January 1990 and March 2012 reporting cardiovascular comorbidity in patients with COPD (or vice versa).

Results

Of the 7,322 citations identified, 25 studies were relevant for this systematic review. Twenty-two studies provided an estimate for CVD risk in COPD, whereas four studies provided estimates of COPD risk in CVD. The crude prevalence for the aggregate CVD category ranged from 28% to 70%, likely due to differences in populations studied and CVD definitions; unadjusted rate ratio (RR) estimates of unspecified CVD among patients with COPD compared with patients without COPD ranged from 2.1 to 5.0. The association between COPD and CVD persisted after adjustment for shared risk factors in the majority of the studies. Two studies found a relationship between the severity of airflow limitation and CVD risk. Increased RRs were observed for individual CVD types, but their estimates varied considerably for congestive heart failure, coronary heart disease, arrhythmias, stroke, arterial hypertension, and peripheral arterial disease.

Conclusions

Available observational data support the hypothesis that COPD is associated with an increased risk of CVD.

Section snippets

Data Sources and Searches

An electronic literature search was conducted via PubMed (which comprises citations from MEDLINE, life science journals, and online books) for observational studies published between January 1990 and March 2012 reporting on CVD in patients with COPD or vice versa. Key terms used included medical subject headings and free texts related to CVD and its types (ie, coronary artery disease, myocardial infarction, heart failure, arrhythmia, and hypertension), and to COPD (specifically “Pulmonary

Results

In total, 25 studies were included in the current analysis; 22 studies provided an estimate for CVD risk in COPD, whereas four studies provided estimates of COPD risk in CVD (Table 1). Twelve studies used a cohort design, seven studies used nested case-control approach, and eight studies were cross-sectional. In the prospective studies, the duration of follow-up ranged from 1 to 27 years. The average age of participants ranged between 55 and 78 years. The percentage of male patients in the

Discussion

In this study, we systematically reviewed the literature to estimate the risk of CVD overall and partitioned into more specific disease types (CHF, CHD, arrhythmias, stroke, arterial hypertension, and PAD) in patients with COPD. To our knowledge, it provides the most comprehensive and systematic review of available information on the topic to date. Main results support that COPD is associated with an increased risk of CVD, with the risk of CVD increasing with the severity of airflow limitation

Acknowledgments

Authors contributions: Dr Müllerova had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Müllerova: contributed to the literature search, creating the tables, and writing the manuscript and served as principle author.

Dr Agusti: contributed to review of the study proposal and the interim results and writing the manuscript.

Dr Erqou: contributed to the literature search, creating the initial review output,

References (51)

  • L Staszewsky et al.

    Clinical, neurohormonal, and inflammatory markers and overall prognostic role of chronic obstructive pulmonary disease in patients with heart failure: data from the Val-HeFT heart failure trial

    J Card Fail

    (2007)
  • YC Wang et al.

    Prevalence and risks of chronic airway obstruction: a population cohort study in Taiwan

    Chest

    (2007)
  • AM Schols et al.

    Resting energy expenditure in patients with chronic obstructive pulmonary disease

    Am J Clin Nutr

    (1991)
  • JB Soriano et al.

    High prevalence of undiagnosed airflow limitation in patients with cardiovascular disease

    Chest

    (2010)
  • H Bahrami et al.

    Novel metabolic risk factors for incident heart failure and their relationship with obesity: the MESA (Multi-Ethnic Study of Atherosclerosis) study

    J Am Coll Cardiol

    (2008)
  • JW Shepard et al.

    Relationship of ventricular ectopy to nocturnal oxygen desaturation in patients with chronic obstructive pulmonary disease

    Am J Med

    (1985)
  • National Heart, Lung, and Blood Institute

    Morbidity and mortality: 2009 chart book on cardiovascular, lung, and blood diseases. 2009. National Heart, Lung, and Blood Institute website

  • DD Sin et al.

    Mortality in COPD: role of comorbidities

    Eur Respir J

    (2006)
  • LP McGarvey et al.

    Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee

    Thorax

    (2007)
  • A Macchia et al.

    The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure

    Eur J Heart Fail

    (2007)
  • A Agustí et al.

    Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype

    PLoS ONE

    (2012)
  • RG Barr et al.

    Percent emphysema, airflow obstruction, and impaired left ventricular filling

    N Engl J Med

    (2010)
  • PM Short et al.

    Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study

    BMJ

    (2011)
  • NB Allen et al.

    Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA

    Neuroepidemiology

    (2010)
  • Y Chen et al.

    Age and sex variations in hospital readmissions for COPD associated with overall and cardiac comorbidity

    Int J Tuberc Lung Dis

    (2009)

    • Cited by (0)

    Funding/Support: This study was sponsored by GlaxoSmithKline plc [study code WEUSKOP4140].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text
    Copyright © 2013 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.