Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients.

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Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD-GOLD) primary care dataset (n=36 282). Accelerated FEV1 decline was defined using the fastest quartile of the COPD population's decline. Cox regression assessed the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease, and CVD mortality). The model was adjusted for age, gender, smoking status, BMI, history of asthma, hypertension, diabetes, statin use, mMRC dyspnoea, exacerbation frequency, and baseline FEV1 percent predicted.6110 (16.8%) COPD patients had a CVD event during follow-up; median length of follow-up was 3.6 years [IQR 1.7-6.1]). Median rate of FEV1 decline was -19.4 mL·year-1 (IQR, -40.5 to 1.9); 9095 (25%) patients had accelerated FEV1 decline (>-40.5 mL·year-1), 27 287 (75%) did not (≤ -40.5 mL·year-1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98 [95%CI, 0.90-1.06]). Corresponding risk estimates were 0.99 (95%CI 0.83-1.20) for heart failure, 0.89 (95%CI 0.70-1.12) for myocardial infarction, 1.01 (95%CI 0.82-1.23) for stroke, 0.97 (95%CI 0.81-1.15) for atrial fibrillation, 1.02 (95%CI 0.87-1.19) for coronary artery disease, and 0.94 (95%CI 0.71-1.25) for CVD mortality. Rather, risk of CVD was associated with mMRC score ≥2 and ≥2 exacerbations in the year prior.CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea but not with accelerated FEV1 decline.

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