Chronic obstructive pulmonary disease and sudden cardiac death: the Rotterdam study
Why the study?
Although COPD has been linked to cardiovascular disease and SCD in specific patient groups, whether an association exists in the general population was unknown.
Does chronic obstructive pulmonary disease increase the risk of sudden cardiac death in subjects aged 45 years and older from the general population?
Structured PICO
Does chronic obstructive pulmonary disease increase the risk of sudden cardiac death in subjects aged 45 years and older from the general population?
P
Population
13,471 subjects aged 45 years and older from the general population (Rotterdam study cohort).
I
Intervention
Diagnosis of chronic obstructive pulmonary disease (COPD)
C
Comparator
Subjects without a diagnosis of chronic obstructive pulmonary disease
O
Outcome
Sudden cardiac death (SCD) over up to 24 years of follow-uphard clinical
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
MNMarieke NiemeijerPhD student, Epidemiology, Erasmus Medical Centre
“The most important way to prevent COPD and SCD is not to smoke and to have a healthy lifestyle. If a person does develop COPD, then this is even more important, as smoking, an unhealthy and a sedentary lifestyle have been proven to increase the risk of SCD. Therefore, smoking cessation is not only important for the course of COPD but also for the development of heart problems and, subsequently, the occurrence of SCD.”
“We are carrying out further research to explore the mechanisms that could explain the high risk of SCD in patients with COPD. We are also looking at the links between the causes of arrhythmias -- irregular heart beats -- and SCD and COPD.”
LHLen HorovitzPulmonary specialist, Lenox Hill Hospital, New York
“Many patients who have COPD are or were smokers, and smoking is the number one cause of heart disease. COPD is also associated with cardiac arrhythmia, such as atrial fibrillation. These events can lead to sudden cardiac death.”
Implication
Chronic obstructive pulmonary disease is an independent risk factor for sudden cardiac death in the general population, particularly in patients with frequent exacerbations >5 years after diagnosis.
Abstract
AIMS: Both sudden cardiac death (SCD) and chronic obstructive pulmonary disease (COPD) are common conditions in the elderly. Previous studies have identified an association between COPD and cardiovascular disease, and with SCD in specific patient groups. Our aim was to investigate whether there is an association between COPD and SCD in the general population. METHODS AND RESULTS: The Rotterdam study is a population-based cohort study among 14 926 subjects aged 45 years and older with up to 24 years of follow-up. Analyses were performed with a (time dependent) Cox proportional hazard model adjusted for age, sex, and smoking. Of the 13 471 persons included in the analysis; 1615 had a diagnosis of COPD and there were 551 cases of SCD. Chronic obstructive pulmonary disease was associated with an increased risk of SCD (age- and sex-adjusted hazard ratio, HR, 1.34, 95% CI 1.06-1.70). The risk particularly increased in the period 2000 days (5.48 years) after the diagnosis of COPD (age- and sex-adjusted HR 2.12, 95% CI 1.60-2.82) and increased further to a more than three-fold higher risk in COPD subjects with frequent exacerbations during this period (age- and sex-adjusted HR 3.58, 95% CI 2.35-5.44). Analyses restricted to persons without prevalent myocardial infarction or heart failure yielded similar results. CONCLUSION: Chronic obstructive pulmonary disease is associated with an increased risk for SCD. The risk especially increases in persons with frequent exacerbations 5 years after the diagnosis of COPD. This risk indicator could provide new directions for better-targeted actions to prevent SCD.
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Cite This Study
Lahousse et al. (2015) studied this question.