Risk of cardiovascular events following COPD hospitalisation: Findings from the China Kadoorie Biobank cohort study

Background: Cardiovascular disease (CVD) is a common co-morbidity in patients with chronic obstructive pulmonary disease (COPD), but the relationship between acute exacerbation requiring COPD hospitalisation (AECOPD) and subsequent risk of CV morbidity or mortality is unclear, particularly in low and middle income countries. Objectives: To examine the risk of CV events following first hospitalized AECOPD. Methods: A prospective cohort included u003e0.5M men and women, aged 30-79 years who were recruited from ten diverse areas (5 rural and 5 urban) in China during 2004-8 and followed up for a mean of 7 years through linkage to death registries and hospital records. We analyzed data from 489,382 participants without prior history of CVD. Cox regression model was used to yield adjusted hazard ratios (HRs) relating hospital admission of incident AECOPD to subsequent incident CVD events. Results: Overall, 10,657 participants were admitted to hospital with a first AECOPD, among them the risk of subsequent CV events (n=1384) were subsequently increased, with adjusted HRs of 1.70 (95% CI 1.56-1.84), 1.69 (1.53-1.87), 1.44 (1.18-1.75), 2.68 (2.27-3.16), 6.85 (5.65-8.32) and 1.89 (1.66-2.15) for major vascular events, ischaemic stroke , haemorrhagic stroke , major coronary events, congestive heart failure and CVD death respectively. Of the CVD events recorded, over 85% of these occurred within 28 days of AECOPD: Conclusion: Among adult Chinese, AECOPD leading to hospitalisation was independently associated with an increased risk of subsequent incident CVD events, especially in the first 28 days post-COPD hospitalisation. (Funded by GSK).