ArticlesRisk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
Introduction
Chronic obstructive pulmonary disease (COPD) is characterised by progressive and partially irreversible airflow limitation, abnormal inflammatory response in the airways, and systemic manifestations.1 As the third leading cause of death worldwide,2 COPD imposes substantial economic and human burdens to both individuals and societies.3, 4 Management of the disease is often complicated by the presence of comorbidities,5 which have been widely recognised as an important component of COPD.6 Cardiovascular comorbidities are one of the most frequent systemic manifestations that have the biggest effect in patients with COPD,1, 7 contributing substantially to disease progression, clinical outcomes, mortality, and resource use.8, 9, 10
Understanding the association between COPD and cardiovascular disease has important implications for disease management, such as targeted treatments and cautions about drug usage. Independent studies have shown a significantly increased risk of cardiovascular disease in patients with COPD, and this was summarised in a recent narrative review.11 However, no previous study has formally quantified the magnitude of the increased risk using quantitative evidence synthesis. Furthermore, the association between cardiovascular risk factors and COPD is not well understood.
With this in mind, we aimed to work out the magnitude of the association between cardiovascular disease and COPD, and between cardiovascular risk factors and COPD in patients with COPD compared with the general population by doing a meta-analysis of observational studies; and to assess the validity of association estimates and potential sources of heterogeneity with modern statistical approaches.
Section snippets
Search strategies
JT and WC independently searched the Cochrane Database of Systematic Reviews, Medline, and Embase databases to identify primary studies and reviews related to the prevalence of cardiovascular diseases in COPD published between Jan 1, 1980, and April 30, 2015 (appendix). The following search terms were used in combination: “chronic obstructive pulmonary disease”, “prevalence”, and “comorbidities”. A sensitive search strategy was developed that included both subject and keyword terms for Medline,
Results
Our literature search and review of reference lists initially identified 18 176 articles. 18 087 articles were subsequently excluded; figure 1 shows the reasons for exclusion. Our meta-analysis included 29 datasets from 27 unique studies.17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 Of the studies included in the meta-analysis, Agarwal and colleages17 reported projected prevalence estimates instead of recorded prevalence. The studies
Discussion
To update and extend the qualitative review by Müllerova and colleagues,11 we quantified the magnitude of risk of cardiovascular disease and risk factor outcomes in COPD through a formal meta-analysis. We found a nearly 2·5 times increased risk of cardiovascular disease overall, a two to five times higher risk of major cardiovascular disease types (ischaemic heart disease, cardiac dysrhythmia, heart failure, diseases of the pulmonary circulation, and arterial diseases), roughly one-third higher
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These authors contributed equally to this work