Chest
ORIGINAL RESEARCHCOPDIncreased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD
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Materials and Methods
We examined The Health Improvement Network (THIN) database, which contains anonymized medical records of primary care practices in England and Wales. The database is comparable to the General Practice Research Database (GPRD)21 and the prevalence, demographics, smoking habits, and mortality of patients with COPD in THIN match other national data.22 The study had approval from the Nottingham Research Ethics committee.
The main analysis used the self-controlled case series approach. This involved
MI and Stroke Incidence Rates
Table 1 reports the total number of patients with COPD and the number experiencing an MI or stroke. There were 25,857 patients with COPD in 277 practices at the start of the observation period. Over the subsequent 2 years, these patients were alive and in contributing practices for 16,874,379 days (average 1.79 years per patient). For all patients with COPD, the incidence rate of MI events was 1.1 per 100 patient-years and for stroke events, 1.4 per 100 patient-years.
Number and Annual Rates of Exacerbations
Table 2 shows the number
Discussion
This study has for the first time, to our knowledge, shown that exacerbation of COPD is associated with a small, but statistically significant, 2.27-fold increased relative risk of MI during a short 5-day period and of a stroke during the 1- to 49-day period immediately following an exacerbation. There are a number of strengths of our study. We examined a large population of patients with COPD. Although the diagnosis of COPD could not be confirmed with spirometry in all patients, we found a
Acknowledgments
Author contributions: Dr Donaldson had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Donaldson: contributed to the original idea for the study, performed the statistical analysis, wrote the initial draft of the paper, edited the paper, and approved the final version.
Dr Hurst: contributed to the original idea for the study, decided which Read codes to use for definitions, wrote the initial draft of the
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Funding/Support: This study was funded by the British Lung Foundation.
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