Skip to main content
Log in

Chronic obstructive pulmonary disease severity and cardiovascular outcomes

  • cardiovascular diseases
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Objective:

To identify predictors of chronic obstructive pulmonary disease (COPD) severity and assess the relation between COPD severity and risk of cardiovascular outcomes.

Study design and setting:

A␣cohort of patients with diagnosed and treated COPD was compiled from the Saskatchewan Health longitudinal databases. We used multivariate modeling to identify predictors of hospitalization for COPD as an indicator of COPD severity, and we used the model to characterize patients according to quintiles of COPD severity. These severity levels were used as independent variables in multivariate models of cardiovascular outcomes.

Results:

Determinants of COPD severity included emphysema, recent nebulizer use, home oxygen services, corticosteroid use, frequent bronchodilator use, pneumonia and prior COPD exacerbation. The 20% of patients with the highest COPD severity were 1.27 (CI: 1.07–1.50) times more likely to have arrhythmia, 1.25 (CI: 1.07–1.46) times more likely to have ischemic heart disease, 1.38 (CI: 1.11–1.71) times more likely to have angina, 2.28 (CI: 1.95–2.66) times more likely to have congestive heart failure, and 1.63 (CI: 1.22–2.16) times more likely to die of cardiovascular causes than the least severe 20% of patients.

Conclusions:

Patients with more severe COPD, as defined by our model, had higher cardiovascular morbidity and mortality than patients with less severe COPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

COPD:

Chronic obstructive pulmonary disease

GOLD:

Global initiative for chronic obstructive lung disease

FEV:

Forced expiratory volume

FEV1 :

Forced expiratory volume in one second

PaO2 :

Arterial oxygen tension

PaCO2 :

Arterial carbon dioxide tension

BMI:

Body mass index

ECG:

Electrocardiogram

LVD:

Left ventricular dysfunction

References

  1. Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X 2003. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J 21(2):347–360

    Article  PubMed  CAS  Google Scholar 

  2. Friedman GD, Klatsky AL, Siegelaub AB 1976. Lung function and risk of myocardial infarction and sudden cardiac death. N Engl J Med 294(20):1071–1075

    Article  PubMed  CAS  Google Scholar 

  3. Sin DD, Man SF 2003 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 107(11):1514–1519

    Article  PubMed  Google Scholar 

  4. Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM 1996 Impaired lung function and mortality risk in men and women: Findings from the Renfrew and Paisley prospective population study. Br Med J 313(7059):711–715

    CAS  Google Scholar 

  5. Curkendall SM, Deluise C, Jones JK, et al. 2006 Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 16(1):63–70

    Article  PubMed  Google Scholar 

  6. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2= 1&intId=989 . 2005. Accessed January 11, 2006

  7. George DL 2004. Chronic obstructive pulmonary disease treatment options. J Manag Care Pharm 10(Suppl 4):S11–S16

    PubMed  Google Scholar 

  8. Briggs DD Jr 2004. Chronic obstructive pulmonary disease overview: Prevalence, pathogenesis, and treatment. J Manag Care Pharm 10(Suppl 4):S3–S10

    PubMed  Google Scholar 

  9. Mannino DM, Ford ES, Redd SC 2003. Obstructive and restrictive lung disease and functional limitation: Data from the Third National Health and Nutrition Examination. J Intern Med 254(6):540–547

    Article  PubMed  CAS  Google Scholar 

  10. Burrows B. Predictors of loss of lung function and mortality in obstructive lung disease. 1991; 340–345

  11. Nishimura K, Izumi T, Tsukino M, Oga T 2002. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 121(5):1434–1440

    Article  PubMed  Google Scholar 

  12. Schols AM, Slangen J, Volovics L, Wouters EF 1998. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157(6 Pt 1):1791–197

    PubMed  CAS  Google Scholar 

  13. Gerardi DA, Lovett L, Benoit-Connors ML, Reardon JZ, ZuWallack RL 1996. Variables related to increased mortality following out-patient pulmonary rehabilitation. Eur Respir J 9(3):431–435

    Article  PubMed  CAS  Google Scholar 

  14. Celli BR, Cote CG, Marin JM, et al. 2004. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350(10):1005–1012

    Article  PubMed  CAS  Google Scholar 

  15. Groenewegen KH, Schols AM, Wouters EF 2003. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 124(2):459–467

    Article  PubMed  Google Scholar 

  16. Incalzi AR, Fuso L, De Rosa M, et al. 1997. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 10(12):2794–2800

    Article  Google Scholar 

  17. Downey W, Beck P, McNutt M, Stang MR, Osei W, Nichol J 2000. Health databases in Saskatchewan. In: Strom BL (ed) Pharmacoepidemiology. John Wiley and Sons, Chichester, England, pp. 325–345

    Chapter  Google Scholar 

  18. Stang M, Wysowski DK, Butler-Jones D 1999. Incidence of lactic acidosis in metformin users. Diabetes Care 22(6):925–927

    PubMed  CAS  Google Scholar 

  19. Suissa S 2003. Effectiveness of inhaled corticosteroids in chronic obstructive pulmonary disease: Immortal time bias in observational studies. Am J Respir Crit Care Med 168(1):49–53

    Article  PubMed  Google Scholar 

  20. Curkendall SM, Mo J, Glasser DB, Rose SM, Jones JK 2004. Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 65(5):715–720

    Article  PubMed  Google Scholar 

  21. Spitzer WO, Suissa S, Ernst P, et al. 1992. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med 326(8):501–506

    Article  PubMed  CAS  Google Scholar 

  22. Habbick B, Baker MJ, McNutt M, Cockcroft DW 1995. Recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids in Saskatchewan. CMAJ 153(10):1437–1443

    PubMed  CAS  Google Scholar 

  23. Allison PD 1999. Logistic Regression Using the SAS System. SAS Institute, Cary, North Carolina

    Google Scholar 

  24. Soriano JB, Maier WC, Visick G, Pride NB 2001. Validation of general practitioner-diagnosed COPD in the UK General Practice Research Database. Eur J Epidemiol 17(12):1075–1080

    Article  PubMed  CAS  Google Scholar 

  25. Render ML, Weinstein AS, Blaustein AS 1995. Left ventricular dysfunction in deteriorating patients with chronic obstructive pulmonary disease. Chest 107(1):162–168

    PubMed  CAS  Google Scholar 

  26. Gan WQ, Man SF, Senthilselvan A, Sin DD 2004. Association between chronic obstructive pulmonary disease and systemic inflammation: A systematic review and a meta-analysis. Thorax 59(7):574–580

    Article  PubMed  CAS  Google Scholar 

  27. Engstrom G, Lind P, Hedblad B, et al. 2002 Lung function and cardiovascular risk: Relationship with inflammation-sensitive plasma proteins. Circulation 106(20):2555–2560

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank cardiologist Toby Barbey, M.D. for adjudication of medical charts and Miriam Gabrysh and Leanne Stricker for abstracting medical records at Saskatchewan hospitals.

Funding: This study was funded by Pfizer, Inc. and Boehringer-Ingelheim Pharmaceuticals. It is based in part on de-identified data provided by the Saskatchewan Department of Health. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Department of Health.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Suellen M. Curkendall.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Curkendall, S.M., Lanes, S., de Luise, C. et al. Chronic obstructive pulmonary disease severity and cardiovascular outcomes. Eur J Epidemiol 21, 803–813 (2006). https://doi.org/10.1007/s10654-006-9066-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-006-9066-1

Keywords

Navigation