Excess risk of major vascular diseases associated with airflow obstruction: a 9-year prospective study of 0.5 million Chinese adults

• Published in: International journal of chronic obstructive pulmonary disease Vol. 13; pp. 855 - 865
• Main Authors: Kurmi, Om P, Li, Liming, Davis, Kourtney J, Wang, Jenny, Bennett, Derrick A, Chan, Ka Hung, Yang, Ling, Chen, Yiping, Guo, Yu, Bian, Zheng, Chen, Junshi, Wei, Liuping, Jin, Donghui, Collins, Rory, Peto, Richard, Chen, Zhengming
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adult; Adults; Age; Aged; Airway Obstruction - diagnosis; Airway Obstruction - epidemiology; Airway Obstruction - mortality; Airway Obstruction - physiopathology; Body mass index; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Chi-Square Distribution; China; China - epidemiology; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; cohort; Comorbidity; Diabetes; Disease control; Ethics; exacerbation; Forced Expiratory Volume; Health insurance; Heart; Heart failure; Humans; Lung - physiopathology; Lung cancer; Lung diseases; Metabolism; Middle Aged; Morbidity; Mortality; Original Research; Prevalence; Prognosis; Proportional Hazards Models; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Respiratory tract diseases; Risk Assessment; Risk Factors; Smokers; Smoking - adverse effects; Smoking - epidemiology; Spirometry; Stroke; Time Factors; Values; Vascular diseases; Vital Capacity; Women; Womens health; China; cohort; China; vascular diseases; chronic obstructive pulmonary disease; exacerbation
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S153641

China has high COPD rates, even among never-regular smokers. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults. We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality. In 2004-2008, a nationwide prospective cohort study recruited 512,891 men and women aged 30-79 years from 10 diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalization for 9 years. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without. Of 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21-1.36). There were also increased risks of hemorrhagic stroke (n=823, HR 1.18, 95% CI 1.09-1.27), major coronary events (n=635, HR 1.33, 95% CI 1.22-1.45), and heart failure (n=543, HR 2.19, 95% CI 1.98-2.41). For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers. Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis.