Atherosclerosis as a risk factor in the prognosis of the survival of patients with COPD

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): no OnBehalf no Atherosclerosis is one of the key medical problems, as it contributes greatly to the structure of morbidity and mortality. Atherosclerosis rarely occurs in isolation, and is often combined with other diseases, including chronic obstructive pulmonary disease (COPD). The study of the significance of atherosclerosis and other key risk factors in the prognosis of COPD was carried out. Materials and methods a study of the nature of the course of COPD for 15 years was carried out at three time control points (2005, 2008 and 2020). The presence of diseases associated with atherosclerosis in history, the severity of dyspnea according to the modified MRC scale and body mass index were taken into account. To assess the significance of the factors, a long-term survival analysis was performed using the Kaplan-Meier method. The statistical significance of the differences between the curves was assessed using the Log-rank test and the Breslow (Generalized Wilcoxon) and Tarone-Ware tests. To assess the influence of various factors and their combinations on long-term survival, a multivariate analysis was carried out using the Cox regression model (proportional hazards model). Results and discussion The study included 170 men, with an average age of 60.09 ± 1.31 years. All patients smoked, the pack-years index was 43.78 ± 1.02. Of the 170 patients included in the study, 119 died by the third time point, which was 70%. The life expectancy of deceased patients averaged 70.48 ± 0.63 years. The main causes of death in patients with COPD are cardiovascular diseases caused by atherosclerosis, cancer, and respiratory failure. The most common cause of death in patients with COPD (68%) is diseases of the circulatory system associated with atherosclerosis. It was found that the presence of atherosclerosis in the anamnesis decreases the survival rate over a 15-year period. The graphs of the Kaplan-Meier survival curve depending on the presence of concomitant cardiovascular diseases in the anamnesis confirm the significance of the differences (p = 0.0194). It was also shown that an increase in the severity of dyspnea is associated with an increased risk of adverse outcomes (p <0.001; ROC analysis, AUC = 0.737 ± 0.038). The analysis of survival using the construction of Kaplan-Meier curves showed that BMI <21 is associated with a poor prognosis (p <0.001; ROC analysis, AUC = 0.827 ± 0.043). The results of the Cox regression model showed that a history of atherosclerosis is a significant predictor of a poor prognosis in patients with COPD in a 15-year follow-up. It was shown that a history of atherosclerosis increases the risk of death in patients with COPD by 1.734 times. Thus, concomitant cardiovascular diseases of atherosclerotic genesis, severe dyspnea and low body weight are a significant factor in the poor prognosis of COPD and should be taken into account when monitoring patients.