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Original Articles

Pattern of Cardiovascular Comorbidity in COPD in a Country with Low-smoking Prevalence: Results from Two-population-based Cohorts from Sweden

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Pages 454-463 | Received 17 Jul 2017, Accepted 09 Oct 2018, Published online: 26 Nov 2018
 

Abstract

Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009–2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV1/FVC <0.70 and the lower limit of normal (LLN5th percentile) of the ratio of FEV1/FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p < 0.001; LLN definition: 42% vs. 24%, p = 0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.

Acknowledgements

The authors thank the staffs of the OLIN and the WSAS studies for important field survey work. Further, the authors thank Universities of Gothenburg and Umeå, and the region of Västra Götaland’s and Norrbotten’s health authorities for additional support.

Disclosure statement

BE received personal fees from AstraZeneca, Novartis and TEVA for lecturing on COPD, not related to the present study. HB received personal fee for lecture about change in prevalence of COPD at a scientific symposium organized by Boehringer Ingelheim 2016 with no relation to the present study. LE received a grant from AstraZeneca NordicBaltic, not related to this study. MA received personal fees from Novartis for participation in advisory board meeting, and from Boehringer Ingelheim for lecturing, neither related to the present study. AL received personal fees from AstraZeneca for lecturing, advisory board participation and writing chapters to be included in information booklet regarding COPD; from Boehringer Ingelheim for lecturing and advisory board participation; from Novartis for lecturing and writing chapters to be included in information booklet regarding COPD; Active Care for lecturing. None of these are related to the present study. ER received grants from AstraZeneca for study on health economy in severe asthma and from GlaxoSmithKline for study on asthma and COPD overlap, neither related to the present study; BL received personal fees from AstraZeneca for lecturing, for advisory board participation, and writing chapters to be included in information booklet regarding COPD; from GlaxoSmithKline for lecturing and advisory board participation; from Novartis for lecturing and writing chapters to be included in information booklet regarding COPD; and grant from Active Care for lecturing. Neither of these are related to the present study.

Additional information

Funding

The Swedish Heart-Lung foundation and the VBG Group Foundation for Asthma and Allergy Research are gratefully acknowledged for financial support.