Elsevier

Annals of Epidemiology

Volume 16, Issue 1, January 2006, Pages 63-70
Annals of Epidemiology

Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada: Cardiovascular Disease in COPD Patients

https://doi.org/10.1016/j.annepidem.2005.04.008Get rights and content

Purpose

To measure prevalence, incidence, and mortality of cardiovascular outcomes among persons with chronic obstructive pulmonary disease (COPD) and to assess the extent these outcomes differ from persons without COPD.

Methods

Retrospective cohort study in longitudinal health care databases maintained by the government of Saskatchewan, Canada. Subjects were persons age 40 years or older who were diagnosed with COPD during 1997–2000 and who received two or more prescriptions for bronchodilators within 6 months of diagnosis. Each subject was matched by age and sex to two controls without COPD or asthma.

Results

Of COPD patients (n = 11,493), 54% were male, and 74% were 65 years or older. Prevalence of all cardiovascular diseases was higher in the COPD group than in the comparison group. After adjusting for cardiovascular risk, odds ratios of prevalence were: arrhythmia 1.76 (confidence interval [CI]: 1.64–1.89), angina 1.61 (CI: 1.47–1.76), acute myocardial infarction 1.61 (CI: 1.43–1.81), congestive heart failure 3.84(CI: 3.56–4.14), stroke 1.11 (CI: 1.02–1.21), pulmonary embolism 5.46 (CI: 4.25–7.02). Risk of hospitalization due to each cardiovascular cause was elevated in the COPD group. The risk ratio for cardiovascular mortality was 2.07 (CI: 1.82–2.36) and all cause mortality was 2.82 (CI: 2.61–3.05).

Conclusions

Persons with diagnosed and treated COPD are at increased risk for hospitalizations and deaths due to cardiovascular diseases.

Section snippets

Background

The research on the prevalence of cardiovascular diseases or the incidence of hospitalization caused by cardiovascular disease in patients with chronic obstructive pulmonary disease (COPD) has been limited. It is recognized, however, that patients with impaired pulmonary function have an elevated risk of cardiovascular disease 1, 2, 3, 4. Previous studies have examined the relationship between patients' forced expiratory volume (FEV1) and heart disease. Hole and colleagues stratified a survey

Data Source

The Province of Saskatchewan provides medical benefits to nearly all residents of Saskatchewan (99%), a population of about one million people (7). As a result, Saskatchewan Health, a provincial government department, has accumulated and maintains longitudinal databases of health care information. The centralized databases include health insurance registration data, physician claims, hospital separations, outpatient prescription drugs, and vital statistics, including date and cause of deaths

Results

The database COPD cohort represented 2.6% of the population in the eligible age groups in Saskatchewan, 2.3% of the women, and 3.0% of the men. The COPD database cohort and comparison group were both 46% female. Fewer females responded to the smoking survey, so their proportion in the survey results was 41% in the COPD group and 43% in the comparison group. Approximately three fourths of the patients in the database study were 65 years and older at their index date, including one quarter who

Discussion

This study provides population-based evidence of higher prevalence and incidence of hospitalization for major cardiovascular events among persons with COPD compared to those without COPD, both with and without adjustment for diagnostic history of cardiovascular risk factors. Most COPD is caused by smoking (20), the adverse cardiovascular effects of which have been amply demonstrated. Due to data limitations, we were not able to separate the cardiovascular effects of smoking from the effects of

Conclusion

Persons with diagnosed and treated COPD are at increased risk for hospitalizations and deaths due to cardiovascular diseases.

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    This study was funded by Pfizer, Inc., and Boehringer-Ingelheim Pharmaceuticals. It is based in part on de-identified data provided by the Saskatchewan Department of Health. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Department of Health.

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