Sex Differences in COPD Symptoms Predict Cardiac Comorbidity

Neil Osterweil

May 19, 2021

Sex-specific differences in the severity of symptoms and prevalence of comorbidities in patients with chronic obstructive pulmonary disease (COPD) may point to different criteria for diagnosing cardiac comorbidities in women and men, a retrospective analysis suggests.

Among 2046 patients in the German COSYCONET (COPD and Systemic Consequences-Comorbidities Net) cohort, most functional parameters and comorbidities and several items on the COPD Assessment Test (CAT) differed significantly between men and women.

In addition, there were sex-specific differences in the association between symptoms and cardiac disease, reported Franziska C. Trudzinski, MD, from the University of Heidelberg, Germany, and colleagues.

(Note: Although the authors used the term "gender" to distinguish male from female, we have used the term "sex" here to refer to biological attributes of individual patients rather than personal identity.)

"[Sex]-specific differences in COPD comprised not only differences in the level of symptoms, comorbidities, and functional alterations but also differences in their mutual relationships. This was reflected in different sets of predictors for cardiac disease," they wrote in a thematic poster presented during the American Thoracic Society (ATS) 2021 International Conference.

GOLD Standard

The investigators conducted an analysis of data on 795 women and 1251 men with GOLD (Global Initiative for Chronic Obstructive Lung Disease) class 1-3 disease from the COSYCONET COPD cohort.

They looked at the patients' clinical history, comorbidities, lung function, CAT scores, and modified Medical Research Council (mMRC) dyspnea score.

The authors used multivariate regression analysis to model potential sex-related differences in the relationship between symptoms in general and CAT items in particular, and the pattern of comorbidities and functional alterations.

They also performed logistic regression analyses to identify predictors for cardiac disease, defined as myocardial infarction, heart failure, or coronary artery disease. The analyses were controlled for age, body mass index (BMI), smoking status, mMRC, CAT items, and z-scores of forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC).

The investigators found significant differences between men and women for most functional parameters and comorbidities, and for CAT items of cough (item 1), phlegm (item 2), and energy (item 8; P < .05 for all comparisons).

In logistic regression analysis, predictors for cardiac disease in men were energy (CAT item 8), mMRC score, smoking status, BMI, age, and spirometric lung function.

In women, however, only age was significantly predictive for cardiac disease.

"Our findings give hints how diagnostic information might be used differently in men and women," Trudzinski et al write.

Reassuring Data

David Mannino, MD, medical director of the COPD Foundation, who was not involved in the study, said in an interview that sex differences in COPD presentation and severity are common.

"In general, men and women report symptoms differently. For example, women don't report a whole lot of chronic bronchitis and phlegm, although they may have it," he said, "whereas men may report less dyspnea. It varies, but in general we know that men and women, even with the same type of disease, report symptoms differently."

Comorbidities also differ between the sexes, he noted. Women more frequently have osteoporosis, and men more frequently have heart disease, as borne out in the study. The prevalence of heart disease among patients in the study was approximately 2.5 times higher in men than women, Mannino noted.

"It's reassuring, because what we're seeing is similar to what we've seen in other [studies] with regards to comorbidities," he said.

The study was sponsored by Philipps University Marburg Medical Center, Germany. The authors and Mannino have reported no relevant financial relationships.

ATS 2021. Abstract A2228. May 14-19, 2021.

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