Chest
Volume 137, Issue 2, February 2010, Pages 333-340
Journal home page for Chest

Original Research
COPD
High Prevalence of Undiagnosed Airflow Limitation in Patients With Cardiovascular Disease

https://doi.org/10.1378/chest.09-1264Get rights and content

Background

The prevalence of airflow limitation (AL) in patients with cardiovascular disease (CVD) is unknown, and whether AL is adequately diagnosed and treated in these patients has not been investigated before, to our knowledge.

Methods

We compared clinical and spirometric data in three groups of individuals. Two of them were participants in the follow-up of an ongoing population-based study according to the presence or absence of CVD. The third group included patients with coronary artery disease (CAD) confirmed by coronariography regularly visited at a tertiary referral university hospital. AL was defined according to the Global Initiative for Obstructive Lung Disease guidelines.

Results

We studied 450 population participants without CVD, 52 population participants with CVD, and 119 hospital patients with CAD. The prevalence of AL in these three groups was 17.5% (95% CI, 14.0–21.0), 19.2% (95% CI, 8.1–30.7), and 33.6% (95% CI, 25.0–42.2), respectively (P < .05). Underdiagnosis of AL ranged from 60% in population participants with CVD up to 87.2% in hospital patients with CAD. Sixty percent of those with spirometrically confirmed AL (in all three groups) did not receive any respiratory treatment.

Conclusions

AL is frequent in individuals with CVD, particularly in those with CAD attended in the hospital, is largely underdiagnosed and therefore is highly undertreated.

Trial registration

Clinicaltrials.gov; Identifier: NCT00787748.

Section snippets

Design of the Study

Figure 1 shows the flowchart of participants. Participants in the follow-up of an ongoing population-based study, the COR Sà Illes Balears (CORSAIB), aimed at investigating the distribution of CVD and CVD risk factors in the general population of the Balearic Islands, Spain, were invited to participate also in our study. The design and full methodological details of the CORSAIB study have been published elsewhere.10 Briefly, it started in 1999 and randomly selected a representative sample,

Sampling

As per Figure 1, we studied 1,113 participants from the original CORSAIB cohort plus a sample of 165 hospital patients with CAD, and spirometry was obtained in 1,002 and all 165, respectively. However, spirometry current quality control standards were only fulfilled by 509 (51%) and 120 (73%), respectively. A nonresponse study was conducted, comparing sociodemographic and clinical variables between the participants whose spirometry did/did not pass spirometry quality control (Table 1). Given

Discussion

COPD is now considered a novel CV risk factor because the burden of CV disease is higher in smokers with COPD than in those without it.6 Yet, the prevalence, level of diagnosis, and adequacy of treatment of COPD among patients with CVD has not been investigated before, to our knowledge. Our results show that one of every three patients with CAD recruited from the hospital clinic, and one of every five patients with CVD in the general population, suffer AL compatible with COPD, that the majority

Conclusions

Our results show that the prevalence of AL in patients with CVD is substantial (one in three CAD patients seen in hospital clinics, and about one in five patients with CVD in the general population), that most of these patients are not diagnosed appropriately (60% in CVD patients from the community and up to 87% in patients with CAD in the hospital), and that the majority of them are not treated whatsoever (60% in all groups). Given that COPD is a preventable and treatable disease,15, 16 this

Acknowledgments

Author contributions: Dr Soriano: contributed to the design and protocol of the study, obtaining funding, developing the plan of analysis, drafting the report, performing statistical analysis, and writing and approving the manuscript.

Dr Rigo: contributed to the design and protocol of the study, obtaining funding, and writing and approving the manuscript.

Ms Guerrero: contributed to statistical analysis and to writing and approving the manuscript.

Dr Yañez: contributed to writing and approving the

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  • Cited by (0)

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

    Funding/Support: This study was supported by research grants [FIS PI061228 for 2007-2009], redIAPP Grupo cardiovascular de Baleares [RD06/0018/0045] from the Instituto de Salud Carlos III, and by a generous donation from Fundación Barceló (www.fundacionbarcelo.org).

    1

    Dr Agustí is currently at the Institut Clínic del Tòrax, Hospital Clínic, Universitat de Barcelona (Barcelona, Spain).

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