Cardiovascular Risks Before and After COPD Diagnosis

Patients with chronic obstructive pulmonary disease (COPD) face a significant cardiovascular burden both before and after diagnosis. Analyses presented at the European Respiratory Society (ERS) Congress 2025 emphasize the need for early recognition and better integrated care strategies to improve outcomes for these patients.

Cardiovascular Events After Severe COPD Exacerbations

A US payer–focused retrospective study assessed real-world cardiovascular events (CVEs) and pharmacologic treatment patterns among patients with severe COPD exacerbations.1 Using the Healthcare Integrated Research Database, researchers examined 48,702 patients aged 40 years and older who experienced a severe exacerbation between October 2016 and January 2024. Nearly 73% of the patient population was non-Hispanic White, with more patients in the unknown race or ethnicity group (17%) than any other category.

Patients were followed for 1 year before and after their index exacerbation. During the post-index period, 31.5% experienced at least 1 additional severe exacerbation, and the sample size dropped by more than 18,000 patients. Medication use also rose after the initial event—prescriptions for long-acting β agonists (LABA) increased from 0.6% to 1.4%, long-acting muscarinic antagonists (LAMA) from 11.1% to 16.0%, and inhaled corticosteroids (ICS) from 3.5% to 6.9%.

Before and after the index period, the 3 most commonly prescribed maintenance therapies were oral corticosteroids (39.8% vs 46%), oxygen therapy (33.1% vs 43.1%), and short-acting β agonists (SABA; 44% vs 52%). The only decline seen after the index period was for macrolide antibiotics, dipping from 26.3% to 24.5%. Roflumilast and short-acting muscarinic antagonist (SAMA) prescriptions never passed 3%.

More than 75% of individuals with COPD had at least 1 core cardiopulmonary event. | Image credit: RFBSIP – stock.adobe.com

Uptake of combination therapies increased across the board:

1. LABA and LAMA, from 5.5% to 8.8%
2. LABA and ICS, from 21.6% to 30.6%
3. LABA, LAMA, and ICS, from 11.5% to 19%
4. SABA and SAMA, from 14.3% to 26%

Additionally, 18.5% of patients had a CVE during the post-index period, and 12.5% of those without prior cardiovascular disease developed a CVE within a year of their exacerbation. These data underscore that severe COPD exacerbations are pivotal events not only for respiratory decline but also for cardiovascular vulnerability, regardless of prior cardiovascular history, according to the researchers.

“The results should be cautiously interpreted as administrative claims data may not accurately reflect diagnosis or treatment patterns,” the researchers noted. “Additional limitations include any unmeasured characteristics that were not accounted for in the study, limited generalisability to populations not studied, and potential misrepresentation of results due to survival bias.”

Cardiopulmonary Risks Before COPD Diagnosis

Complementing the post-diagnosis analysis, the ABACOS RISKS study explored cardiopulmonary events leading up to COPD diagnosis using data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics.2 Researchers identified 77,461 individuals with incident COPD between 2018 and 2019 and compared them with 154,856 matched controls without COPD. The mean age was 68 years, and 93% of the cohort was White.

Findings revealed that cardiovascular risk was already widespread long before diagnosis. More than 75% of individuals with COPD had at least 1 core cardiopulmonary event—including heart failure, myocardial infarction, ischemic stroke, or respiratory tract infection—before diagnosis, compared with about 45% of controls. Odds of experiencing such an event were 3.8 times higher among patients with COPD (95% CI, 3.7-3.9).

Among those with at least 3 years of pre-index data, 56.6% had a core cardiopulmonary event within the 3 years leading up to their diagnosis, with nearly 5 times the odds compared with controls (95% CI, 4.8-5.0). Additionally, 97.2% of patients had at least 1 broad cardiopulmonary risk factor before diagnosis, such as hypertension, diabetes, pneumonia, or lifestyle-related risks like smoking.

“Early recognition and management of cardiopulmonary events could improve early detection of and outcomes in COPD,” the researchers concluded.

References

1. Mayen E, Head M, Biesck N, et al. Cardiovascular events and pharmacological treatment patterns in patients with severe COPD exacerbations: a US payer perspective. Presented at: ERS Congress 2025; September 28, 2025; Amsterdam, Netherlands. https://live.ersnet.org/eposter/presentation/566689
2. Russell R, Pradeep V, Patrick J, et al. Late breaking abstract - prevalence of cardiopulmonary events and risk factors before COPD diagnosis: ABACOS RISKS study. Presented at: ERS Congress 2025; September 29, 2025; Amsterdam, Netherlands. https://live.ersnet.org/eposter/presentation/573035