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Respiratory epidemiology
Coronary heart disease and heart failure in asthma, COPD and asthma-COPD overlap
  1. Truls Sylvan Ingebrigtsen1,2,
  2. Jacob Louis Marott3,
  3. Jørgen Vestbo4,
  4. Børge Grønne Nordestgaard2,3,5,6 and
  5. Peter Lange2,3,7,8
  1. 1Respiratory Section, Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
  2. 2The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  3. 3The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark
  4. 4Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
  5. 5Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  6. 6Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  7. 7Medical department O, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  8. 8Section of Epidemiology, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Peter Lange; peter.lange{at}sund.ku.dk

Abstract

Introduction We investigated risk of coronary heart disease and heart failure in phenotypes of obstructive airway disease.

Methods Among 91 692 participants in the Copenhagen General Population Study, 42 058 individuals were classified with no respiratory disease, and 11 988 individuals had different phenotypes of obstructive airways disease: asthma with early onset or late-onset, chronic obstructive pulmonary disease (COPD) with forced expiratory volume in one second (FEV1) above or below 50% of predicted value (%p) or asthma-COPD overlap (ACO).

Results During a mean follow-up of 5.7 years we registered 3584 admissions for coronary heart disease and 1590 admissions for heart failure. Multivariable Cox regression analyses of time to first admission were used with a two-sided p value of 0.05 as significance level. Compared with no respiratory disease the highest risks of coronary heart disease and heart failure were observed in ACO with late-onset asthma and FEV1 <50% p, HR=2.2 (95% CI 1.6 to 3.0), and HR=2.9 (95% CI 2.0 to 4.3), respectively. In COPD with FEV1 above 50% p the HRs were 1.3 (95% CI 1.2 to 1.5) for coronary heart disease and 1.9 (95% CI 1.6 to 2.3) for heart failure. Asthma associated with increased risks of coronary heart disease and heart failure, however, in asthma without allergy the HR was 1.1 (95% CI 0.7 to 1.6) for coronary heart disease while individuals with allergy had an HR of 1.4 (95% CI 1.1 to 1.6).

Conclusions Risks of coronary heart disease and heart failure were increased in asthma, COPD and ACO. In asthma, the risk of coronary heart disease depended on presence of allergy. We suggest that cardiovascular risk factors should be assessed systematically in individuals with obstructive airway disease with the potential to facilitate targeted treatments.

  • clinical epidemiology
  • COPD epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000470

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    Footnotes

    • Contributors Study concept and design: PL, TSI, JLM, JV, BGN; Acquisition of data: BGN, PL, JLM; Analysis and interpretation of data: TSI, PL, JLM, JV; First drafting of the manuscript: PL and TSI; Critical revision of the manuscript for important intellectual content: All authors; Statistical analysis: JLM, TSI; Obtained funding: BGN, PL; Administrative, technical and material support: BGN, PL; Study supervision: PL, BGN; Data access and responsibility: PL, TSI, JLM. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding Capital Region of Copenhagen, Danish Lung Foundation, Velux Foundation, Herlev Hospital, GlaxoSmithKline (unrestricted grant: EPI 115882 – EUPharmaLocal). JV is supported by the NIHR Manchester BRC. The funding sources had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

    • Competing interests TSI has received fee for speaking from AstraZeneca. JV has received fee for speaking from AstraZeneca, Boehringer Ingelheim, Chiesi and Novartis; received fee for consulting from AstraZeneca, Boehringer Ingelheim, Chiesi and Novartis. PL has received research grants from Astra Zeneca, Boehringer Ingelheim and GlaxoSmithKline; received fee for speaking from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithCline; received fee for consulting from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by institutional review boards and the local Danish ethics committees (H-KF01-144/01), and was conducted according to the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. For this research project a protocol was approved by the board of the Copenhagen General Population Study. Researchers were allowed access to the data in the study through encrypted access.