Cardiovascular prevalence, mortality and associations with treatment in oxygen-dependent COPD - a national cohort study

<bold>Background:</bold> Chronic obstructive pulmonary disease (COPD) is associated with increased risk for cardiovascular disease (CVD). We aimed to explore temporal changes in CVD prevalence and cardiovascular (CV) mortality and associations with treatment in patients with COPD and long-term oxygen therapy (LTOT). <bold>Methods:</bold> Population-based DISCOVERY cohort study using data from 1987 to 2022 from the Swedish National Registry for Respiratory Failure and the National Patient Registry. Annual prevalence of CVD (ischemic heart disease, heart failure, atrial fibrillation/flutter, cerebral infarctions/hemorrhages) at start of LTOT, and all cause- and CV mortality rates per year were calculated. Associations of beta-blockers, ACE/AII-inhibitors, statins and inhaled corticosteroids (ICS) with CV mortality and new acute CV events (myocardial infarctions or cerebral infarctions/hemorrhages) were analysed using Cox regression, adjusting for sex, age, PaO2 on air, body mass index, performance status, forced expiratory volume in one second, CVD and exacerbation frequency at LTOT start. <bold>Results:</bold> During the study period, 18,733 patients (58% women, mean age+SD 74+8 years) started LTOT, and of these 17,066 died. The CVD prevalence at LTOT start changed from 32% in 1989 to 53% in 2022. Mortality rates decreased from 38 to 34 % (all-cause) and from 5.4% to 4.6% (CV). The proportion of CV deaths was unchanged at 14%. ICS treatment was independently associated with lower risk for CV mortality (HR [95%CI] 0.75 [0.66-0.86]) and for new acute CV events (0.78 [0.70-0.87]). <bold>Conclusions:</bold> CVD prevalence but not CV mortality has increased in oxygen-dependent COPD. ICS may be of benefit to prevent CV events.