Risk of acute cardiovascular events in COPD patients after experiencing COVID-19-related vs. non-COVID-19-related exacerbations - a population-based study

Tuesday, August 27, 2024

2:00 PM – 2:15 PM CEST

Location: Conv Hall I C

Presenting Author(s)

Brian K. Kirui, MMedSc

Doctoral student
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
University of Gothenburg
Gothenburg, Sweden

Slides

Co-Author(s)

OW

Oskar Wallström

Doctoral student
COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden, Sweden
LV

Lowie E.G.W Vanfleteren, MD, PhD

Assoc. Prof.
COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden, Sweden
Ailiana Santosa, MD. MMedSc. PhD (she/her/hers)

Senior researcher
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Gothenburg, Sweden
Huiqi Li, PhD

Assoc. Prof.
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sweden
CB

Carl Bonander, PhD

Assoc. Prof.
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sweden
CS

Caroline Stridsman, PhD

Assoc. Prof.
Department of Public Health and Clinical Medicine/The OLIN-unit, Umeå University, Umeå, Sweden., Sweden
MB

Mats Börjesson

Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Sweden
Fredrik Nyberg, MD PhD

Professor of Register Epidemiology
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg
M�lndal, Sweden

Background: Patients with chronic obstructive pulmonary disease (COPD) are prone to exacerbations, many of which are triggered by respiratory viral infections. The relationship between exacerbations of COPD and cardiovascular risk is well known but under-researched in the context of COVID-19.

Objectives: To investigate incidence and risk of acute cardiovascular events following exacerbations due to COVID-19 compared to non-COVID-19-related exacerbations, in a cohort of COPD patients with exacerbations.

Methods: Using data from the linked nationwide Swedish register study SCIFI-PEARL (Swedish Covid-19 Investigation for Future Insights – a Population Epidemiology Approach using Register Linkage), we studied COPD patients with exacerbations in Sweden from Mar2020 to Jun2023. Exacerbations, defined as prescription of oral corticosteroids (moderate) or hospitalization due to COPD (severe) during follow-up, were classified as COVID-19-related (by positive PCR test or hospitalization for COVID-19 within 21 days before or 7 days after an exacerbation record), or otherwise as non-COVID-19-related. Multiple exacerbations at least 28 days apart in the same individual were included. Follow-up extended from each exacerbation until outcome, emigration, death, or end of study. Incidence rate ratios (IRRs) and adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) for the outcomes of myocardial infarction (MI), pulmonary embolism (PE) and stroke related to COVID-19-related exacerbations were estimated, adjusted for age and prior medical history. Robust variance estimators were used to account for multiple exacerbations per subject.

Results: 110,774 COPD patients experienced a total of 455,637 exacerbations during study period. Among these, 2.3% (10,259) were COVID-19-related (exposed), while 97.8% (445,378) were non-COVID-19-related (unexposed). During follow-up, we observed 3,536 MI, 612 PE, and 720 strokes. Crude IRRs for outcomes in exposed vs unexposed were 0.93 for MI, 1.03 for PE, and 1.37 for stroke. COPD patients with exacerbations due to COVID-19 showed no increased risk of MI (aHR 1.00, 95%CI 0.79-1.27), but a modestly elevated yet non-significant risk for PE (1.19,0.70-2.03), and stroke (1.18,0.74-1.91), compared with non-COVID-19 exacerbations.

Conclusions: The relatively low proportion of COVID-19-related exacerbations suggests that COVID-19 was not a primary contributor of exacerbations in COPD patients during the pandemic. COVID-19-related exacerbations do not conclusively demonstrate a different cardiovascular risk from other exacerbations. However, the number of cardiovascular events and the trend towards elevated risk for PE and stroke underscore the importance of monitoring cardiovascular health in COPD patients.