Article Text
Abstract
Objectives Patients with asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and cardiovascular diseases (CVDs) share common risk factors. However, the association between ACOS and the incidence of CVDs has not been reported. This study investigated the relationship between CVDs and ACOS in the general population.
Setting Data were obtained from Taiwan’s National Health Insurance Research Database for the period 2000 to 2010.
Participants The ACOS cohort comprised patients (n=5814) who had received a diagnosis of asthma and COPD. The non-ACOS cohort comprised patients who had not received a diagnosis of asthma or COPD and were matched to the ACOS cohort (2:1) by age, sex and index date (n=11 625).
Primary and secondary outcome measures The cumulative incidence of CVDs—coronary artery disease (CAD), cardiac dysrhythmia (CD) and heart failure (HF)—was calculated. Cox proportional regression analysis was employed to examine the relationship between ACOS and CVDs.
Results After adjustment for multiple confounding factors—age, sex, comorbidities and medications—patients with ACOS were associated with a significantly higher risk of CVDs; the adjusted HRs (aHRs; 95% CI) for CAD, CD and HF were 1.62 (1.50 to 1.76), 1.44 (1.30 to 1.61) and 1.94 (1.73 to 2.19), respectively, whereas those of beta-blockers treatment for CAD, CD and HF were 1.19 (0.92 to 1.53), 0.90 (0.56 to 1.45) and 0.82 (0.49 to 1.38). The aHR of atenolol treatment for CD was 1.72 (1.01 to 2.93). The aHRs (95% CIs) of ACOS without acute exacerbation of COPD (AE-COPD) for CAD, CD and HF were 1.85 (1.70 to 2.01), 1.57 (1.40 to 1.77) and 2.07 (1.82 to 2.35), respectively.
Conclusion ACOS was associated with higher CVD risk, even without the presence of previous comorbidities or AE-COPD. No significant differences in CVD events were observed in the ACOS cohort using beta-blockers, except for those using atenolol for treating CD.
- chronic obstructive pulmonary disease
- asthma–chronic obstructive pulmonary disease overlap syndrome
- cardiovascular diseases
- cohort study
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Footnotes
J-JY and W-HH contributed equally.
Contributors Conceptualisation: J-JY and W-HH. Methodology: C-LL, W-HH and J-JY. Software: C-LL and W-HH. Validation: J-JY, Y-FW, C-LL and W-HH. Formal analysis: J-JY, Y-FW, C-LL and W-HH. Investigation: J-JY and W-HH. Resources: J-JY and W-HH. Data curation: J-JY, Y-FW, C-LL and W-HH. Writing (original draft preparation): J-JY, Y-FW, C-LL and W-HH. Writing (review and editing): J-JY, Y-FW, C-LL and W-HH. Visualisation: J-JY, Y-FW, C-LL and W-HH. Supervision: W-HH and J-JY. Project administration: W-HH and J-JY. Funding acquisition: W-HH.
Funding This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW106-TDU-B-212-113004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036), Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. No additional external funding was received for this study.
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Ethics approval This study was approved as fulfilling the exemption condition by the Institutional Review Board (IRB) of China Medical University Hospital. The IRB number is CMUH104-REC2-115-CR2. The IRB also specifically waived the consent requirement.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The dataset used in this study is held by the Taiwan Ministry of Health and Welfare. All relevant data are provided in the paper.