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Time‐Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial
Dransfield, Mark T. Criner, Gerard J. Halpin, David M. G. Han, MeiLan K. Hartley, Benjamin Kalhan, Ravi Midwinter, Dawn Singh, Dave Wise, Robert Kunisaki, Ken M.
Dransfield, Mark T.
Criner, Gerard J.
Halpin, David M. G.
Han, MeiLan K.
Hartley, Benjamin
Kalhan, Ravi
Midwinter, Dawn
Singh, Dave
Wise, Robert
Kunisaki, Ken M.
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Journal article
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2022-09-14
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Medicine
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http://dx.doi.org/10.1161/jaha.121.024350
Abstract
Background: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. Methods and Results: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time‐dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time‐to‐first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08–3.32]) or severe (HR, 21.84 [95% CI, 17.71–26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28–2.08]; severe: HR, 1.75 [95% CI, 0.99–3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53–3.97]; severe: HR, 41.29 [95% CI, 30.43–56.03]) and decreased in a similar time‐dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. Conclusions: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations.
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Citation
Time‐Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial
Mark T. Dransfield MD mdransfield@uabmc.edu , Gerard J. Criner MD , David M. G. Halpin MD , MeiLan K. Han MD , Benjamin Hartley MMath , Ravi Kalhan MD , Peter Lange MD , David A. Lipson MD , Fernando J. Martinez MD , Dawn Midwinter MSc , Dave Singh MD , Robert Wise MD , and Ken M. Kunisaki MD
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Wiley Open Access
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Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (JAHA), Vol. 11, Iss. 18
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