Chronic obstructive pulmonary disease (COPD) is a common progressive lung disease. People with COPD are at higher risk of heart attacks, and up to one third of patients in this group will die from cardiovascular disease. Cardiovascular disease is therefore an important target area for reducing mortality in people with COPD. Patients with COPD often experience worsening in their symptoms called acute exacerbations of COPD (AECOPD), which are often triggered by infections. It has been suggested that shortly after AECOPD there is a higher chance of having a heart attack, but this hypothesis has not been confirmed yet. In this study, we will investigate if people with COPD are more likely to have a heart attack following AECOPD. We will also investigate factors which might modify this risk. The results of this study will be used to inform our understanding of heart disease in people with COPD and may be used to inform future interventions for reducing the risk of heart attacks in people with COPD.
We will use CPRD linked with HES and ONS to conduct a self-controlled case series to investigate the risk of myocardial infarction (MI) in people with COPD during and shortly after periods of exacerbation compared to stable periods. The self controlled case series method allows the effects of transient exposures on events to be investigated. A major advantage of this method is that fixed confounders are controlled for implicitly. The research team have extensive experience in using this method to investigate the effects of transient vascular risk factors, including the effect of lower respiratory tract infections on risk of MI. We will investigate whether there is an increased risk of MI associated with acute exacerbations of COPD (AECOPD) and investigate the length of the period of potential increased risk. We will also investigate whether severity of AECOPD, concurrent use of cardiovascular drugs, non-MI previous cardiovascular disease, and exacerbator phenotype modifies any risk of MI associated with AECOPD. The findings from this study will be used by clinicians to understand when their COPD patients may be at highest risk of MI and may inform future interventions to reduce this risk.
Jennifer Quint - Chief Investigator - Imperial College London
Kieran Rothnie - Corresponding Applicant - GlaxoSmithKline Services Unlimited (UK)
Hana Mullerova - Collaborator - AstraZeneca Ltd - UK Headquarters
Ian Douglas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Neil Pearce - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data