Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial
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Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease : Post Hoc Analysis From the IMPACT Trial. / Dransfield, Mark T.; Criner, Gerard J.; Halpin, David M.G.; Han, Meilan K.; Hartley, Benjamin; Kalhan, Ravi; Lange, Peter; Lipson, David A.; Martinez, Fernando J.; Midwinter, Dawn; Singh, Dave; Wise, Robert; Kunisaki, Ken M.
I: Journal of the American Heart Association, Bind 11, Nr. 18, e024350, 2022.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease
T2 - Post Hoc Analysis From the IMPACT Trial
AU - Dransfield, Mark T.
AU - Criner, Gerard J.
AU - Halpin, David M.G.
AU - Han, Meilan K.
AU - Hartley, Benjamin
AU - Kalhan, Ravi
AU - Lange, Peter
AU - Lipson, David A.
AU - Martinez, Fernando J.
AU - Midwinter, Dawn
AU - Singh, Dave
AU - Wise, Robert
AU - Kunisaki, Ken M.
N1 - Publisher Copyright: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2022
Y1 - 2022
N2 - BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.
AB - BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.
KW - cardiovascular disease
KW - chronic obstructive pulmonary disease
KW - exacerbations
KW - LAMA/LABA
KW - triple therapy
U2 - 10.1161/JAHA.121.024350
DO - 10.1161/JAHA.121.024350
M3 - Journal article
C2 - 36102236
AN - SCOPUS:85138360499
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 18
M1 - e024350
ER -
ID: 342613177