A retrospective study on chronic obstructive pulmonary disease severity and cardiovascular comorbidities

    Authors

    Keywords

    chronic obstructive pulmonary disease, cardiovascular diseases, therapy exacerbation

    DOI

    https://doi.org/10.15836/ccar2024.114

    Full Text

    **Introduction**: Chronic obstructive pulmonary disease (COPD) is a global health issue characterized by progressive airflow limitation and respiratory symptoms (1, 2). Recent research have shown that patients with COPD often have a higher prevalence of cardiovascular diseases (CVD), including hypertension, coronary artery disease, and congestive heart failure (3, 4). This retrospective study aims to compare prevalence of CVD based on COPD severity. **Patients and Methods**: Data were collected from patients with COPD attending Pulmonology Clinic between April 2023, and October 2023. We divided patients into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I or II (FEV1 >50%) and GOLD stages III or IV (FEV1 0.9 | | | No | 19 (33.9) | 18 (34.0) | 37 (33.9) | | | | | Long-term oxygen therapy | | | | | | | | Yes | 1 (1.8) | 10 (18.9) | 11 (10.1) | | **0.003** | | | No | 55 (98.2) | 43 (81.1) | 98 (89.9) | | | | | Current smoking | | | | | | | | Yes | 27 (48.2) | 17 (32.1) | 44 (40.4) | | 0.1 | | | No | 29 (51.8) | 36 (67.9) | 65 (59.6) | | | | | Exacerbation of COPD over the one year-period | | | | | | | | Yes | 15 (26.8) | 33 (62.3) | 48 (44.0) | | **<0.001** | | | No | 41 (73.2) | 20 (37.7) | 61 (56.0) | | | | [†] COPD = Chronic obstructive pulmonary disease; GOLD = Global Initiative for Chronic Obstructive Lung Disease; * Fisher’s Exact Test FIGURE 1. Comorbidities and cardiovascular diseases among patients depending on the severity of chronic obstructive pulmonary disease. FIGURE 2. The difference in the choice of therapy depending on the GOLD stage (Fisher’s Exact Test). IC = inhaled corticosteroid; LAMA = long-acting muscarinic antagonist; LABA = long-acting β2 agonist; SAMA = short-acting muscarinic antagonist; SABA= short-acting β2 agonist; SS = SAMA+SABA; LL = LAMA+LABA; IL = IC+LABA; ILL = IC+LAMA+LABA. FIGURE 3. The distribution of the use of cardiovascular therapy between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I or II and GOLD stage III or IV groups. BP = blood pressure medication; BB = beta-blockers; CLM = cholesterol-lowering medication, AT = anticoagulant therapy; ASA = aspirin; CG = cardiac glycosides; AA = aldosterone antagonists; D = diuretics. **Conclusion**: Despite prior research, we could not confirm the COPD severity-CVD link. Further research is vital to emphasize the need for personalized care, considering the limitation of a small patient sample.

    Literature

    1. Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet. 2022 June 11;399(10342):2227–42. https://doi.org/10.1016/S0140-6736(22)00470-6
    2. Agarwal AK, Raja A, Brown BD. Chronic Obstructive Pulmonary Disease. 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. https://pubmed.ncbi.nlm.nih.gov/32644707/
    3. Trinkmann F, Saur J, Borggrefe M, Akin I. Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med. 2019 January 10;8(1):69. https://doi.org/10.3390/jcm8010069
    4. Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax. 2022 Jun 30:thoraxjnl-2021-218333. Epub ahead of print. https://doi.org/10.1136/thoraxjnl-2021-218333
    Cardiologia Croatica
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    A retrospective study on chronic obstructive pulmonary disease severity and cardiovascular comorbidities

    Extended Abstract
    Issue3-4
    Published
    Pages114-115
    PDF via DOIhttps://doi.org/10.15836/ccar2024.114
    chronic obstructive pulmonary disease
    cardiovascular diseases
    therapy exacerbation

    Authors

    Ana Kovačević*ORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Stjepan KovačevićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Iva DumančićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Maja FranićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Josipa MeterORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Nikolina BukalORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Ninoslav LekoORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Blaženka MiškićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Katica Cvitkušić LukendaORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia

    *Correspondence email: ana.bardak@gmail.com

    Full Text

    Introduction: Chronic obstructive pulmonary disease (COPD) is a global health issue characterized by progressive airflow limitation and respiratory symptoms (1, 2). Recent research have shown that patients with COPD often have a higher prevalence of cardiovascular diseases (CVD), including hypertension, coronary artery disease, and congestive heart failure (3, 4). This retrospective study aims to compare prevalence of CVD based on COPD severity.

    Patients and Methods: Data were collected from patients with COPD attending Pulmonology Clinic between April 2023, and October 2023. We divided patients into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I or II (FEV1 >50%) and GOLD stages III or IV (FEV1 <50%). We compared groups regarding the frequency of cardiovascular comorbidities, gender, age, treatments, current smoking status, COPD exacerbations in the past year, and hospitalizations. Statistical analysis used IBM SPSS Statistics 26. Categorical variables were analysed with Fisher’s exact test, while numerical variables underwent Student’s t-test. All p-values were two-tailed, with significance set at p = 0.05.

    Results: In this study of 109 COPD patients, those in GOLD stages I or II (n=56) had a mean age of 67.7±12.9 years, and those in GOLD stages III or IV (n=53) had a mean age of 70.6±6.9 years (p=0.2). In GOLD stage III or IV group, had more male patients, higher exacerbations rate, and increased long-term oxygen therapy usage compared to GOLD stage I or II (Table 1). Mean FEV1 in GOLD I or II patients was 65.1±11.1%, while in GOLD III or IV patients, 33.9±10.6% (p<0.001). Hospitalization rates were significantly lower for the former group (0.09±0.3 vs. 0.4±0.6, p=0.005). Figure 1 shows the frequency of CVD depending on GOLD stage, no statistical significance was found between the two. GOLD stage I or II patients significantly more often have LAMA and LABA+LAMA in their therapy, while GOLD stage III or IV patients have SABA+SAMA and IC+LABA+LAMA (Figure 2). Notably, the choice of cardiovascular therapy did not differ significantly between these groups (Figure 3).

    TABLE 1: Baseline characteristics of participants.

    Row 1
    N (%)
    GOLD stage I or II
    N (%)
    GOLD stage III or IV
    N (%)
    Total
    Field 6
    P*
    Gender
    Male
    N (%)
    29 (51.8)
    N (%)
    40 (75.5)
    N (%)
    69 (63.3)
    Field 6
    0.02
    Female
    N (%)
    27 (48.2)
    N (%)
    13 (24.5)
    N (%)
    40 (36.7)
    Cardiovascular disease
    Yes
    N (%)
    37 (66.1)
    N (%)
    35 (66.0)
    N (%)
    72 (66.1)
    Field 6
    >0.9
    No
    N (%)
    19 (33.9)
    N (%)
    18 (34.0)
    N (%)
    37 (33.9)
    Long-term oxygen therapy
    Yes
    N (%)
    1 (1.8)
    N (%)
    10 (18.9)
    N (%)
    11 (10.1)
    Field 6
    0.003
    No
    N (%)
    55 (98.2)
    N (%)
    43 (81.1)
    N (%)
    98 (89.9)
    Current smoking
    Yes
    N (%)
    27 (48.2)
    N (%)
    17 (32.1)
    N (%)
    44 (40.4)
    Field 6
    0.1
    No
    N (%)
    29 (51.8)
    N (%)
    36 (67.9)
    N (%)
    65 (59.6)
    Exacerbation of COPD over the one year-period
    Yes
    N (%)
    15 (26.8)
    N (%)
    33 (62.3)
    N (%)
    48 (44.0)
    Field 6
    <0.001
    No
    N (%)
    41 (73.2)
    N (%)
    20 (37.7)
    N (%)
    61 (56.0)

    COPD = Chronic obstructive pulmonary disease; GOLD = Global Initiative for Chronic Obstructive Lung Disease; * Fisher’s Exact Test

    FIGURE 1. Comorbidities and cardiovascular diseases among patients depending on the severity of chronic obstructive pulmonary disease.

    FIGURE 2. The difference in the choice of therapy depending on the GOLD stage (Fisher’s Exact Test). IC = inhaled corticosteroid; LAMA = long-acting muscarinic antagonist; LABA = long-acting β2 agonist; SAMA = short-acting muscarinic antagonist; SABA= short-acting β2 agonist; SS = SAMA+SABA; LL = LAMA+LABA; IL = IC+LABA; ILL = IC+LAMA+LABA.

    FIGURE 3. The distribution of the use of cardiovascular therapy between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I or II and GOLD stage III or IV groups. BP = blood pressure medication; BB = beta-blockers; CLM = cholesterol-lowering medication, AT = anticoagulant therapy; ASA = aspirin; CG = cardiac glycosides; AA = aldosterone antagonists; D = diuretics.

    Conclusion: Despite prior research, we could not confirm the COPD severity-CVD link. Further research is vital to emphasize the need for personalized care, considering the limitation of a small patient sample.

    Literature

    1. 1.
      Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet. 2022 June 11;399(10342):2227–42.DOI
    2. 2.
      Agarwal AK, Raja A, Brown BD. Chronic Obstructive Pulmonary Disease. 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.PubMed
    3. 3.
      Trinkmann F, Saur J, Borggrefe M, Akin I. Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med. 2019 January 10;8(1):69.DOI
    4. 4.
      Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax. 2022 Jun 30:thoraxjnl-2021-218333. Epub ahead of print.DOI