Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study

Barbara Bonnesen; Pradeesh Sivapalan; Anna Kjær Kristensen; Mats Christian Højbjerg Lassen; Kristoffer Grundtvig Skaarup; Ema Rastoder; Rikke Sørensen; Josefin Eklöf; Tor Biering-Sørensen; Jens-Ulrik Stæhr Jensen

doi:10.1183/23120541.00200-2022

Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study

ERJ Open Res. 2022 Sep 26;8(3):00200-2022. doi: 10.1183/23120541.00200-2022. eCollection 2022 Jul.

Authors

Affiliations

¹ Section of Respiratory Medicine, Dept of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
² Dept of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
³ Dept of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴ Dept of Cardiology, Rigshospitalet, Copenhagen, Denmark.
⁵ Dept of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

Background: Chronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated whether patients with COPD and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma.

Methods: Nationwide multicentre retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity-score matched 1:2 to patients with COPD without asthma. The primary end-point was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularisation or hospitalisation.

Results: A total of 52 386 Danish patients with COPD were included; 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity-score matched: 3690 patients with COPD and asthma versus 7236 patients with COPD without asthma, and similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205). The risk of MACE was higher among patients with asthma and COPD versus COPD without asthma: hazard ratio (HR) 1.25 (95% CI 1.13-1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (95% CI 1.06-1.41, p=0.005) for patients without pre-existing cardiovascular disease.

Conclusion: Among patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20-25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients.