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Abstract：
BACKGROUND: Severe exacerbations of chronic obstructive pulmonary disease (COPD) are known to increase the risk of cardiovascular events. However, this association has not been investigated specifically in patients with COPD in Japan, whose characteristics may differ from those of Western patients (i.e., western Europe, the US, and Canada).
METHODS: This longitudinal retrospective cohort study analyzed secondary claims data and included patients aged ≥ 40 years with COPD (International Classification of Diseases-10 codes J41-J44). All exacerbations occurring during follow-up were measured. Time-dependent Cox models were used to estimate hazard ratios (HRs) for the association between time periods following an exacerbation of COPD (vs. time prior to a first exacerbation) and occurrence of a first hospitalization for a severe fatal or non-fatal cardiovascular event.
RESULTS: The analysis included 152,712 patients with COPD with a mean age of 73.8 years and 37.6% of whom were female. During a median follow-up of 37 months, 63,182 (41.4%) patients experienced ≥ 1 exacerbation and 13,314 (8.7%) patients experienced ≥ 1 severe cardiovascular event. Following an exacerbation of COPD, the risk of a severe cardiovascular event was increased in the first 30 days [adjusted HR (aHR) 1.44, 95% confidence interval (CI) 1.33-1.55] and remained elevated for 365 days post-exacerbation (aHR 1.13, 95% CI 1.04-1.23). Specifically, the risks of acute coronary syndrome or arrhythmias remained significantly increased for up to 180 days, and the risk of decompensated heart failure for 1 year.
CONCLUSIONS: Among Japanese patients with COPD, the risk of experiencing a severe cardiovascular event increased following a COPD exacerbation and remained elevated for 365 days, emphasizing the need to prevent exacerbations.
METHODS: This longitudinal retrospective cohort study analyzed secondary claims data and included patients aged ≥ 40 years with COPD (International Classification of Diseases-10 codes J41-J44). All exacerbations occurring during follow-up were measured. Time-dependent Cox models were used to estimate hazard ratios (HRs) for the association between time periods following an exacerbation of COPD (vs. time prior to a first exacerbation) and occurrence of a first hospitalization for a severe fatal or non-fatal cardiovascular event.
RESULTS: The analysis included 152,712 patients with COPD with a mean age of 73.8 years and 37.6% of whom were female. During a median follow-up of 37 months, 63,182 (41.4%) patients experienced ≥ 1 exacerbation and 13,314 (8.7%) patients experienced ≥ 1 severe cardiovascular event. Following an exacerbation of COPD, the risk of a severe cardiovascular event was increased in the first 30 days [adjusted HR (aHR) 1.44, 95% confidence interval (CI) 1.33-1.55] and remained elevated for 365 days post-exacerbation (aHR 1.13, 95% CI 1.04-1.23). Specifically, the risks of acute coronary syndrome or arrhythmias remained significantly increased for up to 180 days, and the risk of decompensated heart failure for 1 year.
CONCLUSIONS: Among Japanese patients with COPD, the risk of experiencing a severe cardiovascular event increased following a COPD exacerbation and remained elevated for 365 days, emphasizing the need to prevent exacerbations.
摘要：
背景：已知慢性阻塞性肺疾病（COPD）的严重加重会增加心血管事件的风险。然而,这种关联尚未在日本的COPD患者中进行专门调查，其特征可能与西方患者的特征不同(即，西欧,美国,和加拿大）。
方法：这项纵向回顾性队列研究分析了二级索赔数据，纳入年龄≥40岁的COPD患者（国际疾病分类-10代码J41-J44）。测量随访期间发生的所有恶化。时间依赖性Cox模型用于估计COPD加重后时间段之间关联的风险比（HRs）（与首次恶化之前的时间）和首次住院的严重致死性或非致死性心血管事件的发生。
结果：分析包括152,712名COPD患者，平均年龄为73.8岁，其中37.6%为女性。在37个月的中位随访中，63,182例（41.4％）患者经历了≥1次加重，13,314例（8.7％）患者经历了≥1次严重心血管事件。COPD加重后，严重心血管事件的风险在前30天增加[校正后HR(aHR)1.44,95%置信区间(CI)1.33~1.55],并且在加重后365天保持升高(aHR1.13,95%CI1.04~1.23).具体来说,急性冠状动脉综合征或心律失常的风险在长达180天的时间内仍然显著增加，以及1年失代偿性心力衰竭的风险。
结论：在日本COPD患者中，COPD加重后发生严重心血管事件的风险增加，并持续365天，强调需要防止恶化。
方法：这项纵向回顾性队列研究分析了二级索赔数据，纳入年龄≥40岁的COPD患者（国际疾病分类-10代码J41-J44）。测量随访期间发生的所有恶化。时间依赖性Cox模型用于估计COPD加重后时间段之间关联的风险比（HRs）（与首次恶化之前的时间）和首次住院的严重致死性或非致死性心血管事件的发生。
结果：分析包括152,712名COPD患者，平均年龄为73.8岁，其中37.6%为女性。在37个月的中位随访中，63,182例（41.4％）患者经历了≥1次加重，13,314例（8.7％）患者经历了≥1次严重心血管事件。COPD加重后，严重心血管事件的风险在前30天增加[校正后HR(aHR)1.44,95%置信区间(CI)1.33~1.55],并且在加重后365天保持升高(aHR1.13,95%CI1.04~1.23).具体来说,急性冠状动脉综合征或心律失常的风险在长达180天的时间内仍然显著增加，以及1年失代偿性心力衰竭的风险。
结论：在日本COPD患者中，COPD加重后发生严重心血管事件的风险增加，并持续365天，强调需要防止恶化。
