Cardiovascular Disease Profile of Patients With Chronic Obstructive Pulmonary Disease: Results From the National Health and Nutrition Examination Survey (NHANES)

Abstract

Atherosclerotic cardiovascular and cerebrovascular disease (CCVD) is an important comorbidity associated with chronic obstructive pulmonary disease (COPD). We compared the prevalence of CCVD between COPD and non-COPD subjects. Additionally, among subjects without pre-existent CCVD, we compared the short-term (10-year) and lifetime risk of development of CCVD in the two study groups. Methods: Pooled data from NHANES 2007-2010 were used. CCVD was defined as self-reported history of stroke, angina / heart attack, coronary artery disease or congestive heart failure. COPD was defined as either a self-reported history of emphysema or FEV1/FVC ratio<70% on serial spirometric assessment before and after administration of a bronchodilator. Based on predicted risk per standard Framingham criteria, subjects without pre-existing CCVD were classified into three groups: high short-term risk, low short-term/high lifetime risk, low short-term/low lifetime risk for development of CCVD. Results: Prevalence of CCVD was estimated as 20.0 % and 7.4 % in COPD and non-COPD groups (p<0.001). Among subjects with CCVD, prevalence of active/former smokers was significantly higher in the COPD population (92.4%) as compared to controls (58.1%, p<0.001). Using multivariate analysis, COPD appeared to be an independent risk factor for prevalent CCVD [OR (95% CI): 1.7 (1.1-2.6)]. Among subjects without CCVD, there were significant differences in predicted cardiovascular risk between the two groups. In the non-COPD group, prevalence of subjects with high short-term risk, low short-term/high lifetime risk and low short-term/low lifetime risk were 18.9%, 62.7% and 18.4% respectively. In the COPD category, the corresponding prevalence estimates were calculated as 35.8%, 53.2% and 11.1% respectively. Predicted 30-year risk of CCVD was estimated as 47.2% in the COPD group, which was significantly higher than 37.9% in the non-COPD group (p<0.001). Conclusions: We observed a significantly increased prevalence of CCVD among subjects with COPD. Among subjects without pre-existent CCVD, the risk of developing CCVD in the future was significantly higher in the COPD group as compared to the non-COPD group.