October 1, 2024International Journal of COPD9 citationsOpen Access

Prevalence and Impact of Chronic Obstructive Pulmonary Disease in Ischemic Heart Disease: A Systematic Review and Meta-Analysis of 18 Million Patients

KMKaifang MengOklahoma State Department of Health XZXinran ZhangBeijing Forestry University WLWei LiuOklahoma State Department of Health

Structured PICO

What is the prevalence of COPD in patients with ischemic heart disease, and does it impact beta-blocker prescription and clinical outcomes?

Population

18 million patients with ischemic heart disease (IHD) pooled from 82 studies (including administrative databases, observational cohorts, and secondary analyses of RCTs).

Intervention

Presence of comorbid chronic obstructive pulmonary disease (COPD)

Comparator

Absence of COPD (IHD patients without COPD)

Outcome

Prevalence of COPD among individuals with IHD

COPD is a highly prevalent comorbidity in patients with ischemic heart disease (12%) and is significantly associated with the underutilization of beta-blockers and a twofold increased risk of long-term mortality.

Abstract

Background: The prevalence of chronic obstructive pulmonary disease (COPD) in patients with ischemic heart disease (IHD) remains uncertain, and its association with adverse outcomes is frequently overlooked. This study aimed to estimate the prevalence of COPD, and its impact on pharmacological treatment, and clinical outcomes in patients with IHD. Methods: A systematic literature search was conducted in Web of Science, Embase, and PubMed until November 20, 2023. All studies that reported the prevalence of COPD in IHD patients were included, and a random-effects model was employed to calculate the pooled prevalence. Data on cardiovascular risk factors/comorbidities, beta-blockers (BBs) prescription, acute phase outcomes in-hospital mortality, major adverse cardiovascular events (MACE), acute heart failure (AHF), and cardiogenic shock, and long-term mortality were compared according to COPD status. Results: A total of 82 eligible studies that reported the prevalence of COPD in 18 million IHD patients were included. The pooled prevalence of COPD was 12.0% 95% confidence intervals (CI): 9.9%-14.1% in patients with IHD. In subgroup analysis, the prevalence of COPD was highest in North America (15.3%), followed by Europe (10.0%), and Asia (8.8%). In addition, COPD was associated with a higher burden of cardiovascular risk factors/comorbidities, but lower BBs prescription odds ratio (OR) 0.50, 95% CI 0.38-0.66. Moreover, COPD was linked to an increased risk of in-hospital mortality (OR 1.47, 95% CI 1.37-1.58), MACE (OR 1.81, 95% CI 1.44-2.27), AHF (OR 2.14, 95% CI 1.86-2.46), cardiogenic shock (OR 1.30, 95% CI 1.01-1.68), as well as long-term mortality (OR 1.99, 95% CI 1.80-2.20). Conclusion: This meta-analysis demonstrated that COPD is prevalent in IHD, involving 12.0% of IHD patients, and is linked to a lower prescription of BBs, an increased burden of comorbidities, and worse acute phase outcomes and long-term mortality.

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