The sustained increase of cardiovascular risk following COPD exacerbations: meta-analyses of the EXACOS-CV studies

Abstract

Listen

Translate article

BackgroundTheEXAcerbations of COPD and their OutcomeS on CardioVascular disease(EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, however with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalizability and improve precision.MethodsStudies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with COPD diagnosis in 2014–2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled HRs (HRp) of risks in post-exacerbation periods (versusperiods outside exacerbations) were obtained through random effects meta-analysis.ResultsTime periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HRp10.22 (95% CI 5.34–19.57) in days 1–7 and HRp1.24 (95% CI 1.09–1.40) in days 181–365. Risks were elevated for 6 months (HRp1.25, 95% CI 1.01–1.55 in days 31–180) and one year (HRp1.48, 95% CI 1.11–1.96 in days 181–365), following a moderate, or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31–180: HRp1.66 (95% CI 1.14–2.42) and HRp1.61 (95% CI 1.28–2.02) following the first, and the second post-diagnosis exacerbation, respectively.ConclusionRisk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.