Long-term cardiovascular risk after severe exacerbation of chronic obstructive pulmonary disease: a population-based cohort study

Background Exacerbation of chronic obstructive pulmonary disease (ECOPD) has been linked to increased cardiovascular disease (CVD) risk within the first year, yet longer risk is unclear. We aimed to investigate the short- and long-term CVD risks after severe ECOPD. Methods COPD patients who were self-reported or spirometry-detected at baseline, or newly diagnosed during follow-up, were included from the China Kadoorie Biobank. Multiple data sources were used to collect information on ECOPD hospitalization and CVD incidence during follow-up. Time-dependent Cox regression models were used to estimate the HRs (95% CIs) for each risk period following ECOPD compared to the baseline period. Results Of the 46 514 COPD patients, 48.2% were screen-detected, 26.2% self-reported, and 25.6% were newly documented. During a median 11-year follow-up, 1185 acute myocardial infarction, 5778 other ischaemic heart disease, 1078 heart failure, 2390 pulmonary heart disease, 4989 ischaemic stroke, and 1648 intracerebral haemorrhage occurred; and post-ECOPD risks of all outcomes were prominently elevated, with the first-week HRs of 8.60 (5.40–13.70), 6.68 (5.16–8.65), 10.98 (6.74–17.89), 24.76 (19.40–31.60), 3.11 (2.16–4.48), and 2.40 (1.27–4.54), respectively. The risks diminished thereafter but could persist for six years or longer. All three types of COPD patients faced increased risks of most outcomes, with baseline patients bearing higher post-ECOPD risks of other ischaemic heart disease and pulmonary heart disease. Conclusion CVD risks increased considerably after ECOPD, with risks of cardiac diseases and ischaemic stroke lasting six years or longer. Screen-detected COPD patients had a similar burden of ECOPD and subsequent CVD to doctor-diagnosed patients.