Clinical Investigation
Acute Ischemic Heart Disease
Chronic obstructive pulmonary disease after myocardial infarction in the community

https://doi.org/10.1016/j.ahj.2010.05.004Get rights and content

Background

Myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) are frequent and share common risk factors. Yet, studies on MI patients reported limited and conflicting results on the prevalence of COPD, its impact on outcome, and how these may have changed over time. We examined, in a geographically defined community, the prevalence of COPD in patients with MI, its impact on mortality, and how these associations changed over time.

Methods

Residents of Olmsted County, Minnesota, who experienced an MI meeting standardized criteria from 1979 to 2007 were included (3,438, 42% women, mean age 68 ± 15 years). Chronic obstructive pulmonary disease was ascertained from the medical records.

Results

Of 3,438 patients, 415 (12%) had COPD. During the study, COPD prevalence increased from 7% in 1979-1985 to 15% in 2000-2007 (P < .001). Survival was worse in patients with COPD than in those without COPD (5-year survival rate: 46% [95% CI 41%-52%] vs 68% [95% CI 66%-70%], respectively; P < .01). The association between COPD and death was independent of age and risk factors (adjusted hazard ratio 1.30, 95% CI 1.10-1.54, P < .01) and did not change over time.

Conclusions

In a large community of patients with MI, the prevalence of COPD increased over time and was associated with a markedly increased risk of death after MI independently of age, risk factors, and comorbidity. This underscores the importance of this condition and the need to optimize care for these high-risk patients.

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.

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