Effect of cardiovascular risk management on the risk of major acute cardiovascular events in patients with COPD in general practice

<bold>Introduction:</bold> Research has shown that patients with COPD are at increased risk of cardiovascular diseases (CVD). We investigated whether cardiovascular risk management (CVRM) in patients with COPD influences their risk of a first major acute cardiovascular event (MACE). <bold>Method:</bold> We performed a retrospective observational study using de-identified data extracted from electronic health records from 100 Dutch general practices. Patients with COPD aged ≥40 years with no history of CVD and ≥1 year follow-up after COPD diagnosis were included. 4,483 patients with COPD were categorized into three subgroups: ‘complete CVRM after COPD diagnosis’ (n=1,196), ‘incomplete CVRM at any time’ (n=2,875), and ‘complete CVRM before COPD diagnosis’ (n=412), the latter subgroup being excluded from further analysis. Cox regression was used to calculate hazard ratios (HR) for a first MACE (i.e., myocardial infarction (MI), angina pectoris (AP), transient ischemic attack (TIA), stroke, or intermittent claudication) for the ‘complete CVRM after COPD diagnosis’ subgroup relative to the ‘incomplete CVRM at any time’ subgroup. <bold>Results:</bold> The results showed a reduced risk of developing a first MACE (adjusted HR=0.48; 95%CI 0.39-0.58), MI (aHR=0.43; 0.27-0.66), AP (aHR=0.43; 0.27-0.68), stroke (aHR=0.27; 0.17-0.43) and intermittent claudication (aHR=0.42; 0.28-0.63) in the 'complete CVRM after COPD diagnosis' subgroup (all P<0.001). For TIA no reduced risk was observed (P=0.052). <bold>Conclusion:</bold> We conclude that cardiovascular risk management in patients with COPD seems associated with reduced risk of a first event of myocardial infarction, angina pectoris, stroke, and intermittent claudication.