Chronic obstructive pulmonary disease and the risk of cardiovascular diseases
First Online: 27 February 2010 Received: 20 March 2009 Accepted: 05 February 2010 DOI:
Cite this article as: Schneider, C., Bothner, U., Jick, S.S. et al. Eur J Epidemiol (2010) 25: 253. doi:10.1007/s10654-010-9435-7 Abstract
Previous large epidemiological studies reporting on the association between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases mainly focussed on prevalent diseases rather than on the incidence of newly diagnosed cardiovascular outcomes. We used the UK-based General Practice Research Database (GPRD) to assess the prevalence and incidence of cardiovascular diseases in COPD patients aged 40–79 between 1995 and 2005, and we randomly matched COPD-free comparison patients to COPD patients. In nested-case control analyses, we compared the risks of developing an incident diagnosis of cardiac arrhythmias, venous thromboembolism, myocardial infarction, or stroke between patients with and without COPD, stratifying the analyses by COPD-severity, using COPD-treatment as proxy for disease severity. We identified 35,772 patients with COPD and the same number of COPD-free patients. Most cardiovascular diseases were more prevalent among COPD patients than among the comparison group of COPD-free patients. The relative risk estimates of developing an incident diagnosis of cardiac arrhythmia (OR 1.19, 95% CI 0.98–1.43), deep vein thrombosis (OR 1.35, 95% CI 0.97–1.89), pulmonary embolism (OR 2.51, 95% CI 1.62–3.87), myocardial infarction (OR 1.40, 95% CI 1.13–1.73), or stroke (OR 1.13, 95% CI 0.92–1.38), tended to be increased for patients with COPD as compared to COPD-free controls. The findings of this large observational study provide further evidence that patients with COPD are at increased risk for most cardiovascular diseases.
Keywords Arrhythmia Chronic obstructive pulmonary disease Deep vein thrombosis Myocardial infarction Pulmonary embolism Stroke Abbreviations ACE
Angiotensin converting enzyme
Body mass index
Chronic obstructive pulmonary disease
Deep vein thrombosis
Forced expiratory volume in 1 s
General Practice Research Database
Independent Scientific Advisory Committee
Medicines and Healthcare products Regulatory Agency
Transient ischemic attack
Agusti A, Soriano JB. COPD as a systemic disease. Copd. 2008;5(2):133–8.
GOLD. Executive Summary: Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2007
Pinto-Plata VM, Mullerova H, Toso JF, Feudjo-Tepie M, Soriano JB, Vessey RS, et al. C-reactive protein in patients with COPD, control smokers and non-smokers. Thorax. 2006;61(1):23–8.
Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363–9.
Huiart L, Ernst P, Suissa S. Cardiovascular morbidity and mortality in COPD. Chest. 2005;128(4):2640–6.
Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? a multiple cause coding analysis. Eur Respir J. 2003;22(5):809–14.
Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004;125(6):2309–21.
Owens RC Jr, Nolin TD. Antimicrobial-associated QT interval prolongation: pointes of interest. Clin Infect Dis. 2006;43(12):1603–11.
Giovino GA. The tobacco epidemic in the United States. Am J Prev Med. 2007;33(6 Suppl):S318–26.
Sin DD, Man SF. Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease. Can J Physiol Pharmacol. 2005;83(1):8–13.
Johnston AK, Mannino DM, Hagan GW, Davis KJ, Kiri VA. Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort. Thorax. 2008;63(7):599–605.
Rodriguez-Roisin R, Soriano JB. Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease. Proceedings of the American Thoracic Society. 2008;5(8):842–7.
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006;8(9):651–745.
Tillie-Leblond I, Marquette CH, Perez T, Scherpereel A, Zanetti C, Tonnel AB, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med. 2006;144(6):390–6.
Erelel M, Cuhadaroglu C, Ece T, Arseven O. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 2002;96(7):515–8.
Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol. 2007;99(5):636–41.
Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996; 313(7059): 711–5; discussion 15–6.
Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E Jr, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16(1):63–70.
Curkendall SM, Lanes S, de Luise C, Stang MR, Jones JK, She D, et al. Chronic obstructive pulmonary disease severity and cardiovascular outcomes. Eur J Epidemiol. 2006;21(11):803–13.
Sidney S, Sorel M, Quesenberry CP Jr, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest. 2005;128(4):2068–75.
Wood L, Martinez C. The general practice research database: role in pharmacovigilance. Drug Saf. 2004;27(12):871–81.
Soriano JB, Maier WC, Egger P, Visick G, Thakrar B, Sykes J, et al. Recent trends in physician diagnosed COPD in women and men in the UK. Thorax. 2000;55(9):789–94.
Ruigomez A, Johansson S, Wallander MA, Garcia Rodriguez LA. Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK. BMC Cardiovasc Disord. 2005;5:20.
Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestagen components. Lancet. 1995;346(8990):1589–93.
Schlienger RG, Jick H, Meier CR. Use of nonsteroidal anti-inflammatory drugs and the risk of first-time acute myocardial infarction. Br J Clin Pharmacol. 2002;54(3):327–32.
Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM. High risk of cardiovascular disease in patients with type 1 diabetes in the UK: a cohort study using the general practice research database. Diabetes Care. 2006;29(4):798–804.
Soriano JB, Maier WC, Visick G, Pride NB. Validation of general practitioner-diagnosed COPD in the UK General practice research database. Eur J Epidemiol. 2001;17(12):1075–80.
Sarubbi B, Esposito V, Ducceschi V, Meoli I, Grella E, Santangelo L, et al. Effect of blood gas derangement on QTc dispersion in severe chronic obstructive pulmonary disease: evidence of an electropathy? Int J Cardiol. 1997;58(3):287–92.
Buch P, Friberg J, Scharling H, Lange P, Prescott E. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J. 2003;21(6):1012–6.
Mapel DW, Dedrick D, Davis K. Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991–1999. Copd. 2005;2(1):35–41.
Engstrom G, Hedblad B, Valind S, Janzon L. Increased incidence of myocardial infarction and stroke in hypertensive men with reduced lung function. J Hypertens. 2001;19(2):295–301.
Truelsen T, Prescott E, Lange P, Schnohr P, Boysen G. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study. Int J Epidemiol. 2001;30(1):145–51.
Hozawa A, Billings JL, Shahar E, Ohira T, Rosamond WD, Folsom AR. Lung function and ischemic stroke incidence: the Atherosclerosis Risk in Communities study. Chest. 2006;130(6):1642–9.
CrossRef PubMed Copyright information
© Springer Science+Business Media B.V. 2010