Chronic obstructive pulmonary disease in patients admitted with heart failure

IntroductionTo examine the prevalence of chronic obstructive pulmonary disease (COPD) misclassification and the associated burden of symptoms, healthcare utilisation and physical performance status in the Canadian general population. This information...

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

Introduction: Retrospective studies based on clinical data and without spirometric confirmation suggest a poor prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). Impact of undiagnosed COPD in these patients is unknown. The aim of our study was to evaluate the prevalence of COPD in patients with IHD treated with PCI, and prognosis impact of COPD –previously or newly diagnosed- in these patients. Material and Methods: Patients with IHD confirmed by PCI were consecutively included. After PCI, the pacients underwent forced spirometry and evaluation of cardiovascular risk factors. Mortality, new cardiovascular events, and their combined endpoint were analyzed. Results: A total of 133 patients (78% male), with a mean (SD) age of 63 (10.12) years were included. Out of the whole group, 33 (24.8%) met the spirometric criteria for COPD, of which 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected and a greater history of previous IHD. Median follow-up was 934 days (IQR 25-75%: 546-1160). COPD patients had greater mortality (p=0.008; H.R. 8.85; CI 95%:1.76-44.47) and number of cardiovascular events (p=0.024; H.R. 1.87; CI 95%: 1.04-3.33), even those without a previous diagnosis of COPD (p=0.01; H.R.: 1.78; CI 95%: 1.12-2.83). These differences remained after adjustment for possible confounding variables. Conclusions: Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients showed greater mortality and a higher number of cardiovascular events during follow-up.

The impact of heart failure with preserved left ventricular ejection fraction (LVEF) on activated hemostasis is still unclear. We sought to compare the activation of hemostasis in patients with heart failure with preserved LVEF, with impaired LVEF, and in healthy controls. Biomarkers of coagulation and fibrinolysis (D-dimer, tPA and PAI-1) were determined in outpatients with chronic stable (NYHA I-III), optimally managed heart failure with preserved LVEF (n = 46) and with impaired LVEF (n = 52), and in healthy age- and gender-matched controls (n = 14). In comparison to healthy controls, patients with heart failure and preserved LVEF had increased median D-dimer levels (606 [330-1222] microg/L versus 174 [86-249] microg/L; P < 0.001), and median PAI-1 (20 [15.3-33.1] microg versus 6.2[3.4-8.9] microg/L; P < 0.001) and tPA antigen concentrations (9.6 [8.1-13.3] versus 3.6 [2.2-5.0] microg/L; P < 0.001). However, unlike tPA and PAI antigens, D-dimer levels in preserved LVEF did not reach values as high as in impaired LVEF (917 [454-1185] microg/L; P = 0.013). Moreover, in patients with impaired LVEF, but not in those with preserved LVEF, age and NT-proBNP emerged as independent predictors of log-transformed D-dimer levels. Heart failure with preserved LVEF is associated with a procoagulant state as determined by increased levels of D-dimer, tPA and PAI-1 antigens. D-dimer levels are significantly higher in patients with impaired LVEF, while tPA and PAI-1 levels are increased regardless of LVEF.

We aimed to characterize the prevalence and severity of left ventricular (LV) and right ventricular (RV) systolic dysfunction and their prognostic implications in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). We enrolled 256 consecutive contemporary ATTRwt-CM patients. LV systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (LV-GLS), and stroke volume index (SVi), while RV systolic function was assessed using Tricuspid Annular Plane Systolic Excursion (TAPSE). At ATTRwt-CM diagnosis time, median LVEF was 47.5% (Q1-Q3: 40.7%-54.3%). Preserved LVEF (≥ 50%) was observed in 43.4% of patients, mildly-reduced LVEF (40–49%) in 34.4%, and reduced LVEF (< 40%) in 22.3%. LV-GLS (absolute value: 11.9 ± 3.3%) and SVi (28.6 mL/m²; Q1–Q3: 23.3–34.4) were moderately reduced. Among patients with preserved LVEF, 90% had impaired LV-GLS and 57% reduced SVi. Impaired LVEF (< 50%) was associated with higher all-cause mortality compared with preserved LVEF (adjusted hazard ratio [aHR] 2.0; 95% CI: 1.26–3.17). TAPSE was 17.7 ± 5.1 mm and demonstrated an independent association with mortality (aHR 0.92; 95% CI: 0.88–0.96). One-third of patients had preserved LVEF and TAPSE (≥ 18 mm), showing the most favorable prognosis compared with patients with impaired LVEF, TAPSE, or both. LV and RV systolic dysfunction are common at the time of ATTRwt-CM diagnosis and span a broad spectrum of severity. LV-GLS and SVi are frequently impaired despite preserved LVEF, highlighting the need for a multiparametric assessment of LV function. Incorporating TAPSE for RV evaluation may further refine risk stratification, particularly when LVEF is preserved.

Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Schizophrenia: A Population-Based Study

Increased risk of chronic obstructive pulmonary disease in patients with bipolar disorder: A population-based study

Beneficial effects of beta-blockade remain unclear in heart failure patients who have atrial fibrillation (AF), especially in the elderly. We evaluated the effect of nebivolol on cardiovascular outcomes in elderly patients with heart failure and AF. The SENIORS trial showed an overall benefit of nebivolol compared with placebo in 2128 heart failure patients >70 years of age. At baseline, AF was present in 738 (34.7%) patients. The primary outcome was all-cause mortality or cardiovascular hospitalizations. After 21 months, the cumulative incidence of the primary outcome was significantly more common in patients with AF compared with those with sinus rhythm (38.5% vs. 30.4%, respectively, P < 0.001). In patients with AF, nebivolol had no beneficial effect on the primary outcome [nebivolol vs. placebo, 37.1% vs. 39.8%, hazard ratio (HR) 0.92, 95% confidence interval (CI), 0.73-1.17, P = 0.46], in contrast to patients with sinus rhythm (28.1% vs. 32.9%, in the nebivolol vs. placebo group, respectively, HR 0.82, 95% CI 0.67-0.99, P = 0.049). In patients with AF, the primary outcome was similar in the impaired and preserved left ventricular ejection fraction (LVEF) groups (39.0% with LVEF ≤ 35% vs. 37.3% in patients with LVEF > 35%). There was also no evidence of benefit of nebivolol in AF patients stratified by LVEF. Nebivolol failed to improve outcomes in elderly patients with stable heart failure and co-existing AF, irrespective of LVEF. Furthermore, in patients with AF, outcome was comparable between patients with preserved and impaired LVEF.

BackgroundWe examined the association of non-cigarette tobacco use on chronic obstructive pulmonary disease (COPD) risk in the Population Assessment of Tobacco and Health (PATH) Study.MethodsThere were 13,752 participants ≥ 40 years with Wave 1 (W1) data for prevalence analyses, including 6945 adults without COPD for incidence analyses; W1–5 (2013–2019) data were analyzed. W1 tobacco use was modeled as 12 mutually-exclusive categories of past 30-day (P30D) single and polyuse, with two reference categories (current exclusive cigarette and never tobacco). Prevalence and incidence ratios of self-reported physician-diagnosed COPD were estimated using weighted multivariable Poisson regression.ResultsW1 mean (SE) age was 58.1(0.1) years; mean cigarette pack-years was similar for all categories involving cigarettes and exclusive use of e-cigarettes (all > 20), greater than exclusive cigar users (< 10); and COPD prevalence was 7.7%. Compared to P30D cigarette use, never tobacco, former tobacco, and cigar use were associated with lower COPD prevalence (RR = 0.33, (95% confidence interval—CI) [0.26, 0.42]; RR = 0.57, CI [0.47, 0.70]; RR = 0.46, CI [0.28, 0.76], respectively); compared to never tobacco use, all categories except cigar and smokeless tobacco use were associated with higher COPD prevalence (RR former = 1.72, CI [1.33, 2.23]; RR cigarette = 3.00, CI [2.37, 3.80]; RR e-cigarette = 2.22, CI [1.44, 3.42]; RR cigarette + e-cigarette = 3.10, CI [2.39, 4.02]; RR polycombusted = 3.37, CI [2.44, 4.65]; RR polycombusted plus noncombusted = 2.75, CI]1.99, 3.81]). COPD incidence from W2-5 was 5.8%. Never and former tobacco users had lower COPD risk compared to current cigarette smokers (RR = 0.52, CI [0.35, 0.77]; RR = 0.47, CI [0.32, 0.70], respectively). Compared to never use, cigarette, smokeless, cigarette plus e-cigarette, and polycombusted tobacco use were associated with higher COPD incidence (RR = 1.92, CI [1.29, 2.86]; RR = 2.08, CI [1.07, 4.03]; RR = 1.99, CI [1.29, 3.07]; RR = 2.59, CI [1.60, 4.21], respectively); exclusive use of e-cigarettes was not (RR = 1.36, CI [0.55, 3.39]).ConclusionsE-cigarettes and all use categories involving cigarettes were associated with higher COPD prevalence compared to never use, reflecting, in part, the high burden of cigarette exposure in these groups. Cigarette—but not exclusive e-cigarette—use was also strongly associated with higher COPD incidence. Compared to cigarette use, only quitting tobacco was protective against COPD development.

To estimate chronic obstructive pulmonary disease (COPD) prevalence in Uppsala and the impact of risk factors on disease prevalence using the standardised methods of the Burden of Obstructive Lung Disease (BOLD) study initiative. Randomly selected participants, aged 40 years or more (n = 548) responded to a questionnaire regarding smoking habits, respiratory symptoms, medical history, and exposure to airway irritants. Spirometry, with a post-bronchodilator test, was performed and COPD defined as post-bronchodilatory forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) < 0.70 or FEV(1)/FVC < lower limit of normality (LLN). Circulatory inflammatory markers were measured. COPD prevalence was 16.2%, which was the fourth lowest prevalence of COPD, compared with 12 other BOLD centres. Main risk factors for COPD were increasing age [odds ratio (OR) = 2.08 per 10 years] and smoking (OR = 1.33 per 10 pack years). Higher education was protective (OR = 0.70 per 5 years). Previous tuberculosis was an almost significant risk factor for COPD (P = 0.08). Subjects with COPD reported more respiratory symptoms but only 29% had previous doctor diagnosed COPD, asthma, chronic bronchitis or emphysema. Participants with COPD had higher levels of C-reactive protein (P = 0.01), but no difference was observed in interleukin 6 (IL-6) levels. Using LLN instead of the fixed FEV(1) /FVC ratio reduced the prevalence of COPD to 10%. COPD prevalence in Uppsala was similar to other BOLD centres in high-income countries. Apart from known COPD risk factors (age, smoking, lower educational level), a history of tuberculosis may be associated with COPD even in high-income countries. COPD remains under-diagnosed, as only 29% of subjects with COPD had a previously diagnosed lung disorder.

Experience with autologous bone marrow transplantation (ABMT) in patients with impaired left ventricular ejection fraction (LVEF) or heart failure (HF) is limited. We identified 308 consecutive patients who underwent ABMT for Hodgkin's or non-Hodgkin's lymphoma at our institution (1996-2003). Patient characteristics, clinical course and overall survival were compared between patients with preserved ( > or = 50%) or impaired ( < 50%) LVEF. Of the 308 patients identified, 20 had baseline impaired LVEF (four with LVEF < or = 40%, all NYHA class I-II HF). None of the patients with post-ABMT echocardiogram had worsened LVEF (n = 7). Among the 20 patients with impaired LVEF, four patients had reversible cardiac complications post-ABMT (including worsening HF). The two deaths observed in the impaired LVEF group were both due to noncardiac causes. The 5-year survival was similar between patients with preserved and impaired LVEF (P = 0.43). Careful selection of patients with stable, mild-to-moderate HF and impaired LVEF for ABMT can achieve similar long-term survival. As medical care for HF and ABMT improves, the exclusion criteria for ABMT with regard to HF and impaired LVEF should be re-examined.

Prevalence of chronic obstructive pulmonary disease (COPD) not diagnosed in a population with cardiovascular risk factors

Spondyloarthritis (SpA) has been associated with comorbidities, e.g., cardiovascular disease. However, little is known about the relation between SpA and chronic obstructive pulmonary disease (COPD). The aim of the study was to compare the prevalence of COPD in SpA to the general population. Patients with prevalent SpA in Skåne, Sweden, on December 31, 2018, were identified based on diagnostic codes in a regional register on primary care, secondary outpatient care and inpatient care. Population-based controls (5 per SpA case) were matched for age, sex and municipality. The base case definition for COPD required at least two prior visits with a registered COPD diagnosis. Stricter definitions included dispensed prescriptions for COPD and a COPD diagnosis made by a specialist in lung medicine. The prevalence of COPD in patients with SpA and controls, overall and stratified by sex and age, and the corresponding prevalence ratios, were estimated. A total of 3571 patients with SpA (51% male, mean age 53 years) were compared to 17,855 matched controls. The prevalence of COPD in patients with SpA was 37.8/1000, with a prevalence ratio compared to controls of 1.03 (95% CI 0.85–1.24). There were no significant differences in COPD prevalence between patients with SpA and controls in men or women, in any of the age groups, or in analyses using stricter definitions of COPD. In this regional study including data from primary care, the prevalence of COPD was not increased in patients with SpA compared to the background population.

The silent epidemic of COPD in Africa.

ObjectiveVitamin B6 is involved in regulating a variety of biological reactions in cell metabolism, and possesses antioxidant and anti-inflammatory biological functions. 5′-pyridoxal phosphate (PLP) is the main biologically active form of vitamin B6. There is currently no research on the correlation between serum PLP levels and chronic obstructive pulmonary disease (COPD) prevalence. This study aims to explore the relationship between serum PLP levels and COPD prevalence.MethodsThis cross-sectional study included adult participants with complete data on COPD diagnosis and serum PLP levels from 2005 to 2010 National Health and Nutrition Examination Survey (NHANES) database. Generalized linear model (GLM) was employed to analyze the association between serum PLP levels and COPD prevalence. The restricted cubic spline (RCS) curve and threshold effect analysis were used to explore the potential non-linear relationship between serum PLP levels and COPD prevalence. Subgroup analysis was carried out to assess the robustness of the relationship between serum PLP levels and COPD prevalence.ResultsA total of 11,103 participants were included in this study, of whom 830 were diagnosed with COPD. Higher PLP levels are associated with a reduced prevalence of COPD. GLM analysis confirmed that the groups with higher PLP levels (Q3 and Q4) had a significantly lower prevalence rate of COPD compared to the group of Q2. The RCS curves showed a non-linear “L”-shaped relationship between serum PLP levels and COPD prevalence. The threshold effect analysis found a critical point of 43.3 nmol/L. When serum PLP level is below 43.3 nmol/L, there is a negative correlation between serum PLP levels and COPD prevalence (p for overall <0.001, p for nonlinear <0.001). Subgroup analysis and interaction tests confirmed the robustness of the relationship.ConclusionThis study is the first to discover a non-linear relationship between serum PLP levels and COPD prevalence. Higher serum PLP levels are associated with a reduced prevalence of COPD.