Does PRISm or Pre-COPD affect cardiovascular outcomes among COPD-patients in the Swedish National Airway Register?

<bold>Rationale:</bold> COPD and Preserved Ratio Impaired Spirometry (PRISm) is associated with cardiovascular disease (CVD). We aimed to evaluate prevalence of cardiometabolic risk factors and the risk of hospitalisation and mortality from CVD in a real life COPD cohort stratified into pre-COPD, PRISm and COPD. <bold>Methods:</bold> We enrolled patients with a physician diagnosis of COPD registered in the Swedish National Airway Register in 2014-2022 (n=45653) and used the latest registered FEV1 value as the index date. Spirometric patterns on index-date: pre-COPD (FEV1/FVC>0,7 & FEV1≥80%pred.), PRISm (FEV1/FVC>0,7 & FEV1<80%pred.) or COPD (FEV1/FVC<0,7). In a median follow-up time of 3.65 years (index date- Dec 2022), the risk of CVD-hospitalisation and CVD-mortality was calculated adjusting for age, sex, smoking, BMI and CVD, using COPD as the reference. <bold>Results:</bold> Among registered patients, 4.4% had pre-COPD, 9.4% PRISm and 86% COPD. The prevalence of CVD, obesity and diabetes at index date were: pre-COPD: 39%/31%/11%, PRISm: 48%/44%/17%, COPD: 41%/22%/9%. Post index, the risk ratio (RR) (95%CI) of CVD-hospitalisation and CVD-mortality in pre-COPD were 0.87 (0.70-1.07) and 0.47 (0.22-0.99), in PRISm 1.11 (0.97-1.28) and 0.69 (0.44-1.07), when compared with COPD. Pre-COPD compared to stage 1 COPD had a RR for CVD-hospitalisation of 1.07 (0.82-1.40) and CVD-mortality 0.64 (0.27-1.52). PRISm compared to stage 2+ COPD had a RR for cardiovascular hospitalisation of 1.09 (0.95-1.25) and CVD-mortality 0.67 (0.43-1.04). <bold>Conclusion:</bold> In physician diagnosed COPD, PRISm was associated with a higher prevalence of cardiovascular disease, obesity and diabetes than COPD but had a similar risk of CVD outcomes.