Exacerbations of COPD: what CV risk?

LONDON – It is now well established that exacerbations of chronic obstructive pulmonary disease (COPD) increase cardiovascular (CV) risk.

The mechanisms underlying this association are inflammation, but also pulmonary hyperinflation which compresses the heart and hinders blood pumping and oxygenation. Finally, hypoxic vasoconstriction in the lungs can cause pulmonary hypertension and induce right heart failure as well as a reduction in cardiac output.

In a new French cross-over study, EXACOS-CVpresented at the ESC 2024 congress^[1]the Pr Victor Aboyans (CHU Limoges, France) et al. set out to confirm and quantify this excess CV risk and to detail the subtypes of cardiovascular events observed after the COPD exacerbation episode.

From the “PMSI” database (Program for the medicalization of information systems) containing analysis data on the activity of French health establishments, the researchers selected all patients over 40 years old with a diagnosis of COPD, hospitalized for a cardiovascular event between 2018 and 2019 and who had suffered a CV event within 24 weeks following hospitalization for a COPD exacerbation.

The patients were their own controls. The window of interest spanned the 4 weeks preceding a CV event. The previous 4 weeks were considered a “wash out” and the 16 weeks even earlier were the “control” period.

Our study shows that the 4 weeks after hospitalization for an exacerbation of COPD are a period of particular vulnerability on the CV level.
Pr Aboyans

Tripled CV risk after hospitalization for COPD

The results show that 9840 patients suffered a CV event in 2018-2019 that was preceded by at least one COPD exacerbation within 6 months. 66% were men, the average age was 76.8 years and 33% with a high index of social disadvantage. The risk of CV events was tripled after the exacerbation episode in a relatively stable manner regardless of age.

Note that 950 cardiovascular events (10%) led to the patient’s death in hospital.

Hospitalization for COPD exacerbation tended to occur during the month preceding the CV event, and particularly during the first preceding week, suggesting the need for close and immediate medical monitoring following hospitalization for severe COPD exacerbation. COPD.

Collaboration between cardiologists and pulmonologists is essential for patients at high CV risk
Pr Aboyans

No more IC decompensation

Regarding the type of CV events observed, it was mainly decompensation of heart failure (59.8%), but also AF/flutter (8.7%), pulmonary embolism (7.4%), NSTEMI (6.2), stroke (5.2%), peripheral arterial disease (4.6%), STEMI (2.5%), and cardiac arrest resuscitation (2.1%).

The median time between hospitalization for COPD and the occurrence of a CV event was 43 days and that between hospitalization for COPD and intra-hospital death from CV causes was 37 days. The time intervals varied depending on the CV events: resuscitation for cardiac arrest (28 days), acute coronary syndrome (31 days), pulmonary embolism (34 days), AF/flutter (41.5 days), cardiac decompensation (43 days). ), stroke and TIA (62 days) and peripheral arterial disease (71 days).

“Our study confirms the increased cardiovascular risk after an episode of COPD exacerbation. It also shows that 10% of these complications are fatal and that the 4 weeks after hospitalization for an exacerbation of COPD are a period of particular vulnerability on the cardiovascular level. Finally, the timing and amplitude of the risk varies depending on the CV events”, concluded Professor Aboyans, insisting on the fact that “all efforts to reduce COPD exacerbations have a favorable effect on the cardiovascular level and that collaboration between cardiologists and pulmonologists is essential for these patients at high CV risk.”

However, as this study was based on PMSI data, the CV history of the patients was not known and prospective studies to better understand the CV risk associated with COPD exacerbations are necessary.