COPD Independently Increases Cardiovascular-Related Mortality, Not Stroke

Although researchers from Duke University and the Mayo Clinic claimed chronic obstructive pulmonary disease (COPD) was a risk factor for cardiovascular disease, they found it was not independently linked to having a stroke or systemic embolism.

Published in the American Journal of Respiratory and Critical Care Medicine and presented at ATS 2015 in Denver, their study analyzed the records of 1,950 COPD and atrial fibrillation comorbid patients who were enlisted in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISOTLE) trial.

“Other studies have shown that COPD is an independent risk factor for cardiovascular disease, but what hadn’t been studied was whether COPD was an independent risk factor for stroke, specifically among patients with atrial fibrillation,” the study’s contributor, Michael Durheim, MD, a pulmonary and critical care fellow at Duke, said in a statement.

Of the 1,950 patients identified, the authors found they were 54% more likely to die from all causes (adjusted HR 1.54 [95% CI 1.31, 1.82], p < .001), including from cardiovascular and non-cardiovascular factors.

Although, the team discovered COPD was not an independent predictor of stroke-related or systemic embolism-related mortality (adjusted HR 0.86 [95% CI 0.61, 1.21], p = .382) ), the investigators cautioned that COPD leads to the development of conditions that increases the possibility of experiencing a stroke, coronary artery disease, heart attack, and heart failure.

Atrial fibrillation alone is a risk factor for stroke and systemic embolism, since blood clotting is facilitated by the heart irregularly pumping blood, the statement pointed out.

In regards to medications that could curb patients’ stroke or systemic embolism risk, the researchers found no difference in outcomes based on apixaban or warfarin use—regardless of COPD status (HR 0.92 vs 0.78, interaction p = .617).

“The presence of COPD doesn't need to affect provider’s choice of an anticoagulant,” Durheim commented.

“In patients with atrial fibrillation, COPD is associated with increased risk of cardiovascular and non-cardiovascular mortality,” they concluded. “Future studies should explore mechanisms by which COPD impacts cardiovascular outcomes beyond the effects of shared risk factors.”