Author + information
- Received July 30, 2018
- Revision received October 8, 2018
- Accepted November 5, 2018
- Published online April 29, 2019.
- Paul Carter, MBChBa,b,
- Jakub Lagan, LEKARZc,d,
- Christien Fortune, MBChBc,
- Deepak L. Bhatt, MD, MPHe@DLBHATTMD,
- Jørgen Vestbo, DrMedScid,f,
- Robert Niven, MBChBd,f,
- Nazia Chaudhuri, MBChB, PhDd,f,
- Erik B. Schelbert, MD, MSg,h,i,
- Rahul Potluri, MBChBa and
- Christopher A. Miller, MBChB, PhDc,d,j,∗ (, )@OfficialUoM
- aACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, United Kingdom
- bCambridge Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- cDivision of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- dManchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- eBrigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- fDivision of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- gDepartment of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- hUPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
- iClinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- jWellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- ↵∗Address for correspondence:
Dr. Christopher A. Miller, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
Background The relationship between respiratory diseases and individual cardiovascular diseases, and the impact of cardiovascular diseases on mortality in patients with respiratory disease, are unclear.
Objectives This study sought to determine the relationship between chronic obstructive pulmonary disease (COPD), asthma and interstitial lung disease (ILD), and individual cardiovascular diseases, and evaluate the impact of individual cardiovascular diseases on all-cause mortality in respiratory conditions.
Methods The authors conducted a cohort study of all patients admitted to 7 National Health Service hospitals across the North West of England, between January 1, 2000, and March 31, 2013, with relevant respiratory diagnoses, with age-matched and sex-matched control groups.
Results A total of 31,646 COPD, 60,424 asthma, and 1,662 ILD patients were included. Control groups comprised 158,230, 302,120, and 8,310 patients, respectively (total follow-up 2,968,182 patient-years). COPD was independently associated with ischemic heart disease (IHD), heart failure (HF), atrial fibrillation, and peripheral vascular disease, all of which were associated with all-cause mortality (e.g., odds ratio for the association of COPD with HF: 2.18 [95% confidence interval (CI): 2.08 to 2.26]; hazard ratio for the contribution of HF to mortality in COPD: 1.65 [95% CI: 1.61 to 1.68]). Asthma was independently associated with IHD, and multiple cardiovascular diseases contributed to mortality (e.g., HF hazard ratio: 1.81 [95% CI: 1.75 to 1.87]). ILD was independently associated with IHD and HF, both of which were associated with mortality. Patients with lung disease were less likely to receive coronary revascularization.
Conclusions Lung disease is independently associated with cardiovascular diseases, particularly IHD and HF, which contribute significantly to all-cause mortality. However, patients with lung disease are less likely to receive coronary revascularization.
- chronic obstructive pulmonary disease
- heart failure
- interstitial lung fibrosis
- ischemic heart disease
Dr. Lagan is funded by a Clinical Research Training Fellowship from the British Heart Foundation (FS/17/47/32805). Prof. Vestbo is supported by the National Institute for Health Research Manchester Biomedical Research Centre. Dr. Miller is funded by a Clinician Scientist Award (CS-2015-15-003) from the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. Dr. Bhatt has served on the Advisory Boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the Boards of Directors of the Boston VA Research Institute, the Society of Cardiovascular Patient Care, and TobeSoft; served as Chair of the American Heart Association Quality Oversight Committee; has served on Data Monitoring Committees for the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org, and vice-chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), and WebMD (CME steering committees); has other relationships with Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), and VA CART Research and Publications Committee (chair); has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been a site coinvestigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; has been a trustee for the American College of Cardiology; and has performed unfunded research for FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda. Prof. Vestbo has been a consultant for the COPD Phase 2 and 3 program; and has received payment for lectures including service on Speakers Bureau for GlaxoSmithKline, Chiesi Pharmaceuticals, Boehringer Ingelheim, Novartis, and AstraZeneca. Dr. Chaudhuri has served on an Advisory Board for Roche; and has received research grants and educational and travel sponsorship from Roche and Boehringer Ingelheim. Dr. Schelbert has served on Advisory Boards for Bayer and Merck; and has received research materials from Bracco Diagnostics. Dr. Miller has received research grants from Guerbet and Roche. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 30, 2018.
- Revision received October 8, 2018.
- Accepted November 5, 2018.
- 2019 American College of Cardiology Foundation
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