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Exacerbations of Chronic Obstructive Pulmonary Disease and Cardiac Events: A Cohort Analysis

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  • Ken M Kunisaki
  • Mark T Dransfield
  • Julie A Anderson
  • Robert D Brook
  • Peter M. A. Calverley
  • Bartolome R. Celli
  • Courtney Crim
  • Benjamin F Hartley
  • Fernando J. Martinez
  • David E Newby
  • Alexa A Pragman
  • Jørgen Vestbo
  • Julie C. Yates
  • Dennis E Niewoehner
  • SUMMIT Investigators

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Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Early online date14 Feb 2018
Publication statusPublished - 1 Jul 2018


RATIONALE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common, associated with acute inflammation, and may increase subsequent cardiovascular disease (CVD) risk.

OBJECTIVE: Determine if AECOPD events are associated with increased risk of subsequent CVD.

METHODS: A secondary cohort analysis of the Study to Understand Mortality and MorbidITy (SUMMIT) trial, a convenience sample of current/former smokers with moderate COPD from 1,368 centers in 43 countries. All had CVD or increased CVD risk. AECOPD was defined as an increase in respiratory symptoms requiring treatment with antibiotics, systemic corticosteroids and/or hospitalization. CVD events were a composite outcome of cardiovascular death, myocardial infarction, stroke, unstable angina, and transient ischemic attack. All CVD events were adjudicated. Cox proportional hazards models compared the hazard for a CVD event prior to AECOPD versus following AECOPD.

MEASUREMENTS AND MAIN RESULTS: Among 16,485 participants in SUMMIT, 4,704 participants had at least one AECOPD and 688 had at least one CVD event. The hazard ratio (HR) for CVD events following AECOPD was increased, particularly in the first 30 days following AECOPD (HR 3.8; 95%CI: 2.7 to 5.5) and was elevated up to one year post-AECOPD. The 30-day HR following hospitalized AECOPD was more than two-fold greater (HR 9.9; 95%CI: 6.6 to 14.9).

CONCLUSIONS: In COPD patients with CVD or risk factors for CVD, exacerbations confer an increased risk of subsequent CVD events, especially in hospitalized patients and within the first 30 days post-exacerbation. Patients and clinicians should have heightened vigilance for early CVD events following AECOPD. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01313676.

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