Accelerated FEV 1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients.

Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD)-GOLD primary care dataset (n=36 382). Accelerated decline in forced expiratory volume in 1 s (FEV ₁ ) was defined using the fastest quartile of the COPD population's decline. A Cox regression was used to assess the association between baseline accelerated FEV ₁ decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease and CVD mortality). The model was adjusted for age, sex, smoking status, body mass index, history of asthma, hypertension, diabetes, statin use, Modified Medical Research Council (mMRC) dyspnoea score, exacerbation frequency and baseline FEV ₁ % predicted.6110 COPD patients (16.8%) had a CVD event during follow-up; median length of follow-up was 3.6 years (interquartile range (IQR) 1.7-6.1 years). Median rate of FEV ₁ decline was -19.4 mL·year ^-1 (IQR -40.5-1.9); 9095 patients (25%) had accelerated FEV ₁ decline (> -40.5 mL·year ^-1 ), 27 287 (75%) did not (≤ -40.5 mL·year ^-1 ). Risk of CVD and mortality was similar between patients with and without accelerated FEV ₁ decline (HR _adj 0.98, 95% CI 0.90-1.06). Corresponding risk estimates were 0.99 (95% CI 0.83-1.20) for heart failure, 0.89 (95% CI 0.70-1.12) for myocardial infarction, 1.01 (95% CI 0.82-1.23) for stroke, 0.97 (95% CI 0.81-1.15) for atrial fibrillation, 1.02 (95% CI 0.87-1.19) for coronary artery disease and 0.94 (95% CI 0.71-1.25) for CVD mortality. Rather, risk of CVD was associated with a mMRC score ≤2 and two or more exacerbations in the year prior.CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea score but not with accelerated FEV ₁ decline.
Competing Interests: Conflict of interest: H.R. Whittaker reports grants from GSK, AstraZeneca and BI, outside the submitted work. Conflict of interest: C. Bloom reports funding from AstraZeneca, Chiesi and Asthma UK, outside the submitted work. Conflict of interest: A. Morgan has nothing to disclose. Conflict of interest: D. Jarvis reports grants from the European Union and Cystic Fibrosis Trust, outside the submitted work. Conflict of interest: S.J. Kiddle reports grants from the Medical Research Council (grant number MR/P021573/1), during the conduct of the study; and personal fees from Roche Diagnostics and DIADEM, outside the submitted work. Conflict of interest: J.K. Quint reports grants from the British Lung Foundation, during the conduct of the study; grants and personal fees from AstraZeneca, BI, Bayer and GSK, and grants from Asthma UK, the Medical Research Council and Chiesi, outside the submitted work.
(Copyright ©ERS 2021.)