Abstract
BackgroundChina has high COPD rates, even among never-regular smokers. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults.ObjectiveWe aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality.Materials and methodsIn 2004–2008, a nationwide prospective cohort study recruited 512,891 men and women aged 30–79 years from 10 diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalization for 9 years. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without.ResultsOf 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21–1.36). There were also increased risks of hemorrhagic stroke (n=823, HR 1.18, 95% CI 1.09–1.27), major coronary events (n=635, HR 1.33, 95% CI 1.22–1.45), and heart failure (n=543, HR 2.19, 95% CI 1.98–2.41). For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers.ConclusionAmong adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis.
Highlights
Airflow obstruction (AFO) is a hallmark of COPD
The main aim of the present study is to examine the associations of prevalent airflow obstruction (AFO) with subsequent risk of vascular diseases, including subtypes
The present study provides large-scale prospective evidence that individuals with prevalent AFO have increased risk of major vascular diseases, with risk increased proportionally with increasing severity of AFO
Summary
Airflow obstruction (AFO) is a hallmark of COPD. COPD is a common chronic condition with different phenotypes, and is associated with multiple comorbidities.[1]. Most previous studies of COPD exacerbation with vascular and nonvascular diseases (eg, lung cancer, musculoskeletal disorders, depression, and diabetes) were conducted in Western populations, involving primarily patients in hospital settings. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults. Objective: We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21–1.36). Conclusion: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality.
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