COPD Linked to Cardiovascular Death, But Not Stroke

While chronic obstructive pulmonary disease (COPD) is linked to an increased risk of death from cardiovascular disease, it is not associated with the likelihood of stroke or systemic embolism, according to findings presented at the American Thoracic Society meeting in Denver in May.

Researchers from Duke University and the Mayo Clinic conducted a large, randomized trial of atrial fibrillation patients in order to determine the effectiveness of apixaban and warfarin — 2 anticoagulants – for reducing stroke or systemic embolism risk in COPD patients. This trial was part of the larger ARISTOTLE trial, and it included more than 18,000 patients. The overarching ARISTOTLE trial aims to determine connections between COPD patients and stroke.

COPD was present in about 10 percent of the total ARISTOTLE trial patients for whom pulmonary disease history data was available. The patients who had COPD were typically older, more often men, and more likely to be current or former smokers, the researchers said. The researchers found that the COPD patients also were more likely to suffer from other diseases which could put them at higher risk for cardiovascular diseases such as stroke. Those other conditions included coronary artery disease, a prior heart attack, or heart failure.

But after adjusting for these factors and other patient characteristics, COPD was not associated with increased risk for stroke or systemic embolism. However, the researchers said COPD was linked to increased mortality from all causes by 54 percent, including from both cardiovascular and non cardiovascular death.

“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,” explained Michael Durheim, MD, a pulmonary and critical care fellow at Duke, in a press release.

The authors added that because COPD independently raises mortality in patients with atrial fibrillation, but that further studies should be conducted to “elucidate the mechanisms” that COPD contributes to the increased mortality. The results of those studies, they commented, could be able to chance clinical practices.

In comparing the effect of apixaban to warfarin on stroke or systemic embolism, the researchers learned that the results were not different between subjects with and without COPD.

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