COPD Tied to Elevated Risk for Sudden Cardiac Death

Diana Swift

April 29, 2015

Individuals with chronic obstructive pulmonary disease (COPD) have a greater than one third overall increased risk for sudden cardiac death (SCD) compared with healthy age- and sex-matched adults, according to new research from the Rotterdam Study.

More than 5 years after COPD diagnosis, SCD risk almost doubles, and in patients with frequent exacerbations, the risk rises more than threefold, Lies Lahousse, PhD, a postdoctoral researcher in respiratory medicine at Ghent University Hospital in Belgium, and colleagues report in an article published online April 28 in the European Heart Journal.

"These data could facilitate accurate risk stratification and pave the path to targeted preventive actions for patients with COPD," the authors write.

The large, population-based health study, founded in 1990, has followed health outcomes in 14,926 community-dwelling volunteers, aged 45 years and older, for up to 24 years.

Of the 13,471 persons included in the present analysis, 1615 had a diagnosis of COPD. These participants were somewhat older than those without COPD (70 vs 63 years), more likely to be male (56% vs 40%), and more likely to be current smokers (40% vs 19%).

Overall, there were 551 cases of SCD, including 82 among patients with COPD. After adjustment for age and sex, COPD was associated with a 34% increased risk for SCD (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.06 - 1.70).

The risk was particularly exaggerated beyond 2000 days (5.48 years) after COPD diagnosis (age- and sex-adjusted HR, 2.12: 95% CI, 1.60 - 2.82). The researchers did not see a similar trend for other causes of death.

Among patients with a higher degree of baseline systemic inflammation, those patients with frequent exacerbations such as coughing and dyspnea had a more than threefold increase in SCD risk (age- and sex-adjusted HR, 3.58; 95% CI, 2.35 - 5.44).

The investigators note that the findings were not substantially different when they excluded individuals with a history of myocardial infarction or heart failure.

Previous studies have shown an association between COPD and cardiovascular disease and between COPD and SCD in specific high-risk patient groups. This is the first study to look at the connection in the general population, according to the authors.

Among a host of possible causative mechanisms, the researchers noted COPD's association with an increased risk for ventricular arrhythmias and prolongation of the heart's QTc interval, a phenomenon related to common COPD comorbidities such as coronary heart disease and heart failure. They also point out that several characteristics typical of COPD are also risk factors for SCD, including a higher resting heartrate, hypoxia, hypoxemia, cardiac ischemia, and heart failure.

This specific research was supported by grants/fellowships from the Fund for Scientific Research Flanders, the Netherlands Organisation for Health Research and Development, and the Belgian Thoracic Society. One author is employed at ErasmusAGE, a center for aging research funded by Nestlé Nutrition, Metagenics Inc., and AXA. The other authors have disclosed no relevant financial relationships.

Eur Heart J. Published online April 28, 2015. Abstract

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