# Long-term cardiovascular risk after severe exacerbation of COPD: a population-based cohort study

## TL;DR

Severe COPD flare-ups significantly increase cardiovascular risks for up to six years, with similar risks seen in both diagnosed and screen-detected COPD patients.

## Contribution

Demonstrates that severe COPD exacerbations elevate cardiovascular risks for over six years and that screen-detected COPD has similar long-term risks as diagnosed COPD.

## Key findings

- Severe COPD exacerbations are linked to elevated cardiovascular risks for up to six years.
- Screen-detected COPD patients face similar long-term cardiovascular risks as those with doctor-diagnosed COPD.
- Risks for heart failure and pulmonary heart disease are highest in patients with COPD at baseline.

## Abstract

Exacerbation of COPD (ECOPD) has been linked to increased cardiovascular disease (CVD) risk within the first year, yet longer term risk is unclear. We aimed to investigate the short-term and long-term CVD risks after severe ECOPD.

Patients with self-reported or spirometry-detected COPD at baseline and patients with newly documented COPD during follow-up were included from the China Kadoorie Biobank. Multiple data sources were used to collect information on ECOPD hospitalisation and CVD incidence during follow-up. Time-dependent Cox regression models were used to estimate the hazard ratios and 95% confidence intervals for each risk period following ECOPD compared to the baseline period.

Of the 46 514 patients included, 48.2% had screen-detected COPD, 26.2% had self-reported COPD and 25.6% had newly documented COPD. 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 cases occurred. Post-ECOPD risks of all outcomes were prominently elevated, with first-week hazard ratios (95% CI) 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 6 years or longer. All three categories of patients with COPD faced increased risks of most outcomes, with patients with COPD at baseline bearing higher post-ECOPD risks of other ischaemic heart disease and pulmonary heart disease.

CVD risks increased considerably after ECOPD, with risks of cardiac diseases and ischaemic stroke increased for 6 years or longer. Patients with screen-detected COPD had a similar burden of ECOPD and subsequent CVD to patients with doctor-diagnosed COPD.

After severe ECOPD, many CVD risks increase considerably and can persist for over 6 years. Screen-detected COPD carries a similar burden of ECOPD and subsequent CVD as doctor-diagnosed COPD, suggesting an opportunity for early detection and treatment.
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