Increased risk of Myocardial Infarction and Stroke following Exacerbation of Chronic Obstructive Pulmonary Disease.
Chest. 2009 Dec 18;
Authors: Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA
OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) are at risk of cardiovascular events. This has been attributed to increased systemic inflammation. The course of COPD is punctuated by exacerbations, which further increase systemic inflammation, but the risk of vascular events in the post-exacerbation period has never been defined. DESIGN: We analysed data from 25,857 COPD patients entered in The Health Improvement Network (THIN) database over a two year period. Exacerbations were defined using a health care utilization definition of prescription of oral corticosteroids >20mg/day and/or selected oral antibiotics. The risk of myocardial infarction (MI) and stroke in the post-exacerbation period was calculated relative to the patient's baseline risk using the self-controlled case series approach. RESULTS: We identified 524 MI in 426 patients and 633 ischaemic strokes in 482 patients. The incidence rates of MI and stroke were 1.1 and 1.4 per 100 patient years respectively. There was a 2.27 fold (95% CI 1.1-4.7; P=0.03) increased risk of MI 1-5 days after exacerbation (defined by prescription of both steroids and antibiotics). This relative risk diminished progressively over time and was not significantly different from the baseline MI risk at any other post-exacerbation time interval. One in 2,513 exacerbations was associated with MI within 1-5 days. There was a 1.26 fold (95% CI 1.0-1.6; P=0.05) increased risk of stroke 1-49 days after exacerbation. CONCLUSION: The results suggest that exacerbations of COPD increase the risk of myocardial infarction and stroke. This may have implications for therapy in both stable and exacerbated COPD.
PMID: 20022970 [PubMed - as supplied by publisher]