Chest
Volume 128, Issue 4, October 2005, Pages 2068-2075
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Clinical Investigations
COPD and Incident Cardiovascular Disease Hospitalizations and Mortality: Kaiser Permanente Medical Care Program

https://doi.org/10.1378/chest.128.4.2068Get rights and content

Study objectives

To determine the relationship between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality.

Design

Retrospective matched cohort study.

Setting

Northern California Kaiser Permanente Medical Care Program (KPNC), a comprehensive prepaid integrated health-care system.

Patients or participants

Case patients (n = 45,966) were all KPNC members with COPD who were identified during a 4-year period from January 1996 through December 1999. An equal number of control subjects without COPD were selected from KPNC membership and were matched for gender, year of birth, and length of KPNC membership.

Measurements and results

Follow-up conducted for hospitalization and mortality from CVD end points through December 31, 2000. CVD study end points included cardiac arrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure (CHF), stroke, pulmonary embolism, all of the aforementioned study end points combined, other CVD, and all CVD end points. The mean follow-up time was 2.75 years for case patients and 2.99 years for control subjects. The risk of hospitalization was higher in COPD case patients than in control subjects for all CVD hospitalization and mortality end points. The relative risk (RR) for hospitalization for the composite measure of all study end points was 2.09 (95% confidence interval [CI], 1.99 to 2.20) after adjustment for gender, preexisting CVD study end points, hypertension, hyperlipidemia, and diabetes, and ranged from 1.33 (stroke) to 3.75 (CHF). The adjusted RR for mortality for the composite measure of all study end points was 1.68 (95% CI, 1.50 to 1.88), ranging from 1.25 (stroke) to 3.53 (CHF). Younger patients (ie, age < 65 years) and female patients had higher risks than older and male participants.

Conclusions

COPD was a predictor of CVD hospitalization and mortality over an average follow-up time of nearly 3 years. The finding of a stronger relationship of COPD to CVD outcomes in patients < 65 years of age suggests that CVD risk should be monitored and treated with particular care in younger adults with COPD.

Section snippets

Study Setting

The study population was drawn from members of the KPNC, aged ≥ 40 years. The KPNC provides comprehensive prepaid integrated health care to its approximately 3.2 million subscribers, who comprise > 25% of the population in the areas served. The subscribers are ethnically, racially, and socioeconomically heterogeneous, and are reflective of the local population except for being somewhat more educated, on average, and underrepresentative of the extremes of income.12 In the age group targeted for

Results

We identified a total of 45,966 persons, age ≥ 40 years who satisfied the case definition for COPD. The gender and age distribution of case patients and control subjects are shown in Table 1. Fifty-five percent of the case patients were men. The mean age of case patients and control subjects was 64.4 years (SD, 12.2 years).

The prevalence at baseline of comorbidities in case patients and control subjects is shown in Table 2. The COPD case group had a higher prevalence of each of the comorbid

Discussion

The main finding of this study was that persons with diagnosed and treated COPD identified in this large integrated health-care population had a higher risk of incident hospitalization and mortality for each of the CVD end points studied, relative to age-matched and gender-matched control subjects. All rates for CVD end points were substantially higher in case patients than in control subjects, most notably so for CHF. Relative to the control subjects, the prevalence of baseline medical

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This research was funded by grants from Pfizer, Inc. and Boehringer Ingelheim, Inc.

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