A multidimensional BODEx score >4 independently predicted all-cause mortality (HR 2.19) in patients with stable COPD, superseding cardiovascular disease history as a prognostic factor in advanced disease.
Cohort (n=553)
Yes
Does cardiovascular disease prevalence and its impact on mortality vary by COPD severity in stable COPD patients?
Cardiovascular disease prevalence and its impact on mortality are paradoxically higher in mild-to-moderate COPD compared to severe COPD, highlighting the need for early cardiovascular screening in early-stage pulmonary disease.
Effect estimate: HR 2.19 (95% CI 1.66-2.89)
Absolute Event Rate: 53.4% vs 32.3%
p-value: p=<0.001
Background: Cardiovascular disease (CVD) is a major comorbidity in chronic obstructive pulmonary disease (COPD). However, whether cardiovascular burden increases with the severity of COPD requires more nuanced investigation. This study investigated the association between COPD severity and CVD prevalence, and evaluated their independent and joint effects on long-term survival. Methods: This multicenter cohort study included 553 stable COPD patients. Disease severity was stratified by GOLD grades and the multidimensional BODEx index. Logistic regression and Cox proportional hazards models were used to evaluate CVD prevalence across severity stages and identify predictors of all-cause mortality. Results: Patients were classified as mild-to-moderate (GOLD 1– 2; 57.7%) or severe-to-very severe (GOLD 3– 4; 42.3%). A clear paradox emerged: CVD prevalence was significantly lower in severe-to-very severe COPD compared to mild-to-moderate disease (45.7% vs. 59.6%, P=0.001). Adjusted analysis indicated that severe airflow limitation was independently associated with lower odds of CVD (OR 0.68, P=0.038). Notably, CVD was a significant mortality predictor only in early-stage disease. Conversely, in advanced COPD, the multidimensional BODEx score > 4 emerged as the strongest independent predictor of mortality (HR 2.19, P< 0.001), rendering CVD history statistically non-significant (P=0.10). Conclusion: CVD burden is highest in mild-to-moderate stages, where it significantly drives mortality. In advanced disease, overall multidimensional severity (BODEx index) supersedes CVD to determine survival. These findings emphasize prioritizing early cardiovascular screening in mild COPD while utilizing multidimensional indices for advanced prognosis. Keywords: BODEx index, cardiovascular diseases, mortality, phenotype, pulmonary disease, chronic obstructive
Zhang et al. (Mon,) conducted a cohort in Stable chronic obstructive pulmonary disease (COPD) (n=553). BODEx index >4 vs. BODEx index ≤4 was evaluated on All-cause mortality (HR 2.19, 95% CI 1.66-2.89, p=<0.001). A multidimensional BODEx score >4 independently predicted all-cause mortality (HR 2.19) in patients with stable COPD, superseding cardiovascular disease history as a prognostic factor in advanced disease.