Association of CVD With Respiratory Disease

Study Questions:

What is the relationship and impact on mortality of specific cardiovascular diseases with chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD)?

Methods:

Three study groups included all patients ≥18 years of age with a diagnosis of COPD, asthma, or ILD who were admitted to any of 7 National Health Service hospitals in the North West of England between January 1, 2000, and March 31, 2013. The three study groups and three age- and sex-matched control groups were evaluated by various statistical methods for associations with specific cardiovascular diseases and to assess the contribution of individual cardiovascular diseases to all-cause mortality in patients with COPD, asthma, or ILD.

Results:

Study groups included 31,642 patients with COPD, 60,424 with asthma, and 1,662 with ILD. Control groups were 5 times the size of each study group. Logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals of relationships between respiration conditions and specific cardiovascular diseases. Multivariable Cox regression analyses examined the contribution of CVD to all-cause mortality. Ischemic heart disease, heart failure, atrial fibrillation, cerebrovascular disease, and peripheral vascular disease all increased mortality in patients with COPD, asthma, and ILD, except that atrial fibrillation did not contribute in ILD patients. The greatest hazard ratios for contribution to mortality occurred with cerebrovascular disease and heart failure. Adjustments for age, sex, ethnicity, the cardiovascular diseases and procedures, and other leading causes of death in the United Kingdom were included in the multivariable models.

Table 1. Multivariable-Adjusted Association of Cardiovascular Diseases With Each Respiratory Disease

 

COPD (OR)

Asthma (OR)

ILD (OR)

Ischemic Heart Disease

1.742

1.483

1.571

Heart Failure

2.167

--

2.234

Atrial Fibrillation

1.391

--

--

Cerebrovascular Disease

--

inverse (0.767)

inverse (0.606)

Peripheral Vascular Disease

1.849

inverse (0.792)

--

Percutaneous Coronary Intervention

inverse (0.484)

inverse (0.753)

inverse (0.418)a

Coronary Artery Bypass Graft Surgery

inverse (0.422)

inverse (0.597)

inverse (0.469)b

Except as noted, p value <0.001 for all associations.
a p = 0.001
b p = 0.017

Conclusions:

Cardiovascular diseases were found to be independently associated with COPD, asthma, and ILD. Cardiovascular diseases, particularly heart failure and cerebrovascular disease, independently contributed to all-cause mortality in these patients. Although ischemic heart disease was associated with and contributed to mortality in pulmonary patients, those with respiratory disease were less likely to receive percutaneous coronary interventions or coronary artery bypass graft surgery.

Perspective:

The authors indicate that this is the first study to demonstrate the contribution of several individual cardiac diseases to mortality in patients with COPD, asthma, and ILD. Heart failure was strongly associated with respiratory disease and mortality. Inflammation and fibrosis are widely hypothesized to be causative factors in this association.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Vascular Medicine

Keywords: Respiratory Tract Diseases, Respiratory Tract Infections, Lung Diseases, Interstitial, Pulmonary Disease, Chronic Obstructive, Peripheral Vascular Diseases, Cerebrovascular Disorders, Heart Failure, Myocardial Ischemia, Atrial Fibrillation, Asthma, National Health Programs, England, Percutaneous Coronary Intervention, Coronary Artery Bypass


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