Clinical InvestigationAcute Ischemic Heart DiseaseChronic obstructive pulmonary disease after myocardial infarction in the community
Section snippets
Study population: the Rochester Epidemiology Project
Rochester and Olmsted County, Minnesota, are relatively isolated from other urban centers; and nearly all medical care is delivered to local residents by a few providers. The characteristics of the population of Olmsted County are similar to those of US whites.18 Olmsted Medical Center, Mayo Clinic, and their affiliated hospitals provide comprehensive care in every specialty. Each provider uses a unified medical record system whereby all information is accumulated in a single file. The
Results
Between 1979 and 2007, 3,454 incident MIs occurred in Olmsted County. Sixteen patients diagnosed with pulmonary fibrosis or restrictive lung disease were excluded, resulting in 3,438 patients included in the analysis. Mean age at index was 68 ± 15 years; 42% were women. A clinical diagnosis of COPD was noted among 415 patients, corresponding to a 12% prevalence of COPD among patients with MI in the community. During the 29 years of the study, the prevalence of COPD increased >2-fold from 7% in
Discussion
Among a large geographically defined incident MI cohort, COPD was relatively frequent and carried an increased risk of death. The strong association between COPD and death following MI was independent of sex and other major risk factors and was greater in younger patients. Over time, COPD has become more frequent; and the association between COPD and increased risk of death, after adjustment for age and sex, remained stable over time.
Conclusions
In a large geographically defined community of patients with MI, COPD occurred relatively frequently; and its prevalence increased over time. Chronic obstructive pulmonary disease markedly increased the risk of death after MI independently of age, risk factors, and comorbidity. This excess risk, together with the increasing prevalence of COPD in the community and the aging of the population, underscores the importance of COPD for public health and clinical practice and the need to optimize the
Disclosures
Conflict of interest: The authors state that they have no conflict of interest regarding the content of the article.
Acknowledgements
We thank Kay A. Traverse, RN; Susan Stotz, RN; and Kristie K. Shorter for their support with the study.
References (33)
- et al.
From COPD to chronic systemic inflammatory syndrome?
Lancet
(2007) - et al.
Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction. SPRINT Study Group
Am J Med.
(1992) - et al.
Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes
Am J Cardiol
(2007) - et al.
The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature
Chest
(2005) - et al.
Coronary artery bypass grafting in patients with COPD
Chest
(1998) History of the Rochester Epidemiology Project
Mayo Clin Proc
(1996)- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers
Chest
(2005) - et al.
Symptoms of chronic bronchitis and the risk of coronary disease
Lancet
(1996) - et al.
Uncontrolled immune response in acute myocardial infarction: unraveling the thread
Am Heart J
(2008)
C-reactive protein and heart failure after myocardial infarction in the community
Am J Med
Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease
J Am Coll Cardiol
Chronic obstructive pulmonary disease
N Engl J Med
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary
Am J Respir Crit Care Med.
Trends in the Incidence and Survival of Patients with Hospitalized Myocardial Infarction, Olmsted County, Minnesota, 1979 to 1994
Ann Intern Med
Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease
Circulation
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