Abstract
BACKGROUND: Meta-analyses have suggested that the risk of cardiovascular disease events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation, but the populations at highest risk have not been well characterized to date. METHODS AND RESULTS: The authors analyzed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and patient factors associated with ASCVD hospitalizations after COPD hospitalization among 2 high-risk patient cohorts. The primary outcome was risk of an ASCVD hospitalization composite outcome (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, stroke, transient ischemic accident) after COPD hospitalization relative to before COPD hospitalization. Additional analyses evaluated for risk factors associated with the composite ASCVD hospitalization outcome. In the high-risk primary prevention cohort, the hazard ratio (HR) estimate following adjustment for the composite ASCVD hospitalization outcome after COPD hospitalization versus before COPD hospitalization for 30 days was 0.74 (95% CI, 0.66-0.82; P≤0.0001); for 90 days, 0.69 (95% CI, 0.64-0.75; P≤0.0001); and for 1 year, 0.78 (95% CI, 0.73-0.82; P≤0.0001). In the secondary prevention cohort, the HR for 30-day hospitalization was 1.15 (95% CI, 1.05-1.26; P=0.0036); 90-day hospitalization, 1.08 (95% CI, 1.01-1.15; P=0.0178); and 1-year hospitalization, 1.07 (95% CI, 1.02-1.11; P=0.0026). Among the 19 characteristics evaluated, hyperlipidemia and history of acute ASCVD event were associated with the highest risk of ASCVD events 1 year after COPD hospitalization in the high-risk primary and secondary prevention cohorts. CONCLUSIONS: The risk of ASCVD hospitalization was higher in patients with established ASCVD and lower among high-risk patients without established ASCVD after-COPD hospitalization relative to before hospitalization. We identified multiple risk factors for ASCVD hospitalization after COPD hospitalization.