Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction and often co-exists with cardiovascular disease (CVD), hypertension and diabetes. This international study assessed the association between airflow obstruction and these comorbidities. 23,623 participants (47.5% males, 19.0% current smokers, age: 55.1 ± 10.8 years) in 33 centers in the Burden of Obstructive Lung Disease (BOLD) initiative were included. 10.4% of subjects had airflow obstruction. Self-reports of physician-diagnosed CVD (heart disease or stroke), hypertension and diabetes were regressed against airflow obstruction (post-bronchodilator FEV1/FVC < 5th percentile of reference values), adjusting for age, sex, smoking (including pack-years), body mass index and education. Analyses were undertaken within center and meta-analyzed across centers checking heterogeneity using the I2-statistic. Crude odds ratios for the association with airflow obstruction were 1.42 (95% CI: 1.20–1.69) for CVD, 1.24 (1.02–1.51) for hypertension, and 0.93 (0.76–1.15) for diabetes. After adjustment these were 1.00 (0.86–1.16) (I2:6%) for CVD, 1.14 (0.99–1.31) (I2:53%) for hypertension, and 0.76 (0.64–0.89) (I2:1%) for diabetes with similar results for men and women, smokers and nonsmokers, in richer and poorer centers. Alternatively defining airflow obstruction by FEV1/FVC < 2.5th percentile or 0.70, did not yield significant other results. In conclusion, the associations of CVD and hypertension with airflow obstruction in the general population are largely explained by age and smoking habits. The adjusted risk for diabetes is lower in subjects with airflow obstruction. These findings emphasize the role of common risk factors in explaining the coexistence of cardio-metabolic comorbidities and COPD.
Highlights
Non-communicable diseases, including cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are responsible for almost 70% of global deaths, the majority occurring in low- and middle-income countries [1]
We assessed the association between spirometrically identified post-bronchodilator airflow obstruction and the prevalence of diabetes, hypertension, and CVD in the general population, taking into account the potential impact of age, sex, smoking, body mass index. AO (BMI) and education
We demonstrated that CVD and hypertension were more prevalent in subjects with airflow obstruction, but that this association was confounded by known cardiovascular risk factors, principally aging and smoking
Summary
Non-communicable diseases, including cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are responsible for almost 70% of global deaths, the majority occurring in low- and middle-income countries [1]. Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow obstruction that is due to airway and/or alveolar abnormalities [2]. COPD and CVD often co-exist [3]. A meta-analysis by Chen et al reported a nearly 2.5 times increased risk of CVD in patients with COPD [4]. Hypertension, diabetes and smoking, which all increase the risk for CVD, were more often reported in COPD [4]. All the studies included in that meta-analysis were conducted in Western countries and most of them defined COPD by physician diagnosis and not by spirometry. As COPD is often misdiagnosed [5], these analyses might not provide an accurate account of the relationship between airflow obstruction and comorbidities
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