Chronic Obstructive Pulmonary Disease (COPD) is a lung disease. Symptoms include cough, sputum, and breathlessness. The main cause of COPD is smoking. We know that people who have COPD also often also have cardiovascular diseases. People with COPD die more from heart-related events than lung-related events. There is also a relationship between COPD exacerbations (sudden worsening of COPD symptoms, beyond day-to-day variations, often requiring treatment) and major cardiovascular events (such as heart attacks and heart failure), where cardiovascular events are more likely to occur after a COPD exacerbation. What we do not know, however, is whether there a COPD exacerbation is more likely to happen after a cardiovascular event. We also do not know whether the type of cardiovascular event (such as heart attacks, strokes, heart rhythm problems, or heart failure) results in differences in subsequent COPD exacerbations, cardiovascular events, or death.
Using routinely collected electronic healthcare records from both GP practices and hospitals, this research aims to understand the effect of cardiovascular events in COPD patients on their future (i) COPD exacerbations, (ii) cardiovascular events, and (iii) death. We would also like to examine whether the type of cardiovascular event (such as heart failure, or heart rhythm problem, or stroke) influences future COPD exacerbations, cardiovascular events, or death.
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease, characterised by airway obstruction. Cardiovascular disease (CVD) is highly prevalent amongst people with COPD. There is a well-established association between COPD and CVD, including evidence that the risk of major adverse cardiovascular events (MACE) is significantly increased following a COPD exacerbation (acute amplification of COPD symptoms, beyond the day-to-day variations). Furthermore, COPD exacerbation severity mediates the exacerbation-MACE relationship: severe exacerbations result in greater MACE risk than moderate exacerbations. What is unknown is whether the reciprocal is true: whether MACE alters risk of COPD exacerbations, and whether MACE alters the risk of COPD exacerbation severity. We also do not know whether the type of MACE (such as acute coronary syndrome [ACS], arrhythmia, heart failure [HF], or ischaemic stroke) mediates the risk of subsequent COPD exacerbation, MACE, or mortality in people with COPD.
Using Clinical Practice Research Datalink (CPRD) Aurum primary care data, linked with Hospital Episode Statistics (HES) secondary care data and Office of National Statistics (ONS) death data, we will conduct a cohort study between 1 January 2010 and 31 December 2022 (or to the end of available linked data) on people with a validated COPD diagnosis. Within people with COPD, compared by whether or not people have had a MACE (ACS, arrhythmia, HF, or stroke), we will investigate the risk of (i) future COPD exacerbation and (ii) mortality. Additionally, we will stratify COPD exacerbation outcomes by COPD severity, and stratify mortality by cause (all-cause, COPD-specific, or cardiovascular-specific). To address whether MACE subtype mediates adverse outcomes in people with COPD, we will also stratify our MACE exposure (ACS versus no ACS, arrhythmia versus no arrhythmia, HF versus no HF, and stroke versus no stroke) to investigate how individual MACE subtypes affect risk of future COPD exacerbations, subsequent MACE, and mortality.
1. COPD exacerbations, including:
a. As a binary outcome (exacerbation versus no exacerbation);
b. COPD severity (moderate, managed in primary care; or severe, managed in secondary care);
c. COPD exacerbation count over follow-up;
2. Major adverse cardiovascular events (MACE), defined in secondary care only, including:
a. Acute coronary syndrome (ACS);
b. Arrhythmia;
c. Heart failure (HF);
d. Ischaemic stroke (stroke);
3. Mortality, defined by ONS data, including:
a. All-cause;
b. COPD-specific;
c. Cardiovascular-specific.
Jennifer Quint - Chief Investigator - Imperial College London
Anne Ioannides - Corresponding Applicant - Imperial College London
Emily Graul - Collaborator - Imperial College London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation