Prevalence and Impact of Chronic Obstructive Pulmonary Disease in Ischemic Heart Disease: A Systematic Review and Meta-Analysis of 18 Million Patients

Kaifang Meng,1– 5,* Xinran Zhang,2– 6,* Wei Liu,2– 5,7 Zhichao Xu,1– 5 Bingbing Xie,2– 5 Huaping Dai1– 5,7 1Capital Medical University, Beijing, 100069, People’s Republic of China; 2National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China; 3National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China; 4State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, 100029, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China; 6Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China; 7Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100029, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huaping Dai, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Email [email protected]: The prevalence of chronic obstructive pulmonary disease (COPD) in patients with ischemic heart disease (IHD) remains uncertain, and its association with adverse outcomes is frequently overlooked. This study aimed to estimate the prevalence of COPD, and its impact on pharmacological treatment, and clinical outcomes in patients with IHD.Methods: A systematic literature search was conducted in Web of Science, Embase, and PubMed until November 20, 2023. All studies that reported the prevalence of COPD in IHD patients were included, and a random-effects model was employed to calculate the pooled prevalence. Data on cardiovascular risk factors/comorbidities, beta-blockers (BBs) prescription, acute phase outcomes [in-hospital mortality, major adverse cardiovascular events (MACE), acute heart failure (AHF), and cardiogenic shock], and long-term mortality were compared according to COPD status.Results: A total of 82 eligible studies that reported the prevalence of COPD in 18 million IHD patients were included. The pooled prevalence of COPD was 12.0% [95% confidence intervals (CI): 9.9%– 14.1%] in patients with IHD. In subgroup analysis, the prevalence of COPD was highest in North America (15.3%), followed by Europe (10.0%), and Asia (8.8%). In addition, COPD was associated with a higher burden of cardiovascular risk factors/comorbidities, but lower BBs prescription [odds ratio (OR) 0.50, 95% CI 0.38– 0.66]. Moreover, COPD was linked to an increased risk of in-hospital mortality (OR 1.47, 95% CI 1.37– 1.58), MACE (OR 1.81, 95% CI 1.44– 2.27), AHF (OR 2.14, 95% CI 1.86– 2.46), cardiogenic shock (OR 1.30, 95% CI 1.01– 1.68), as well as long-term mortality (OR 1.99, 95% CI 1.80– 2.20).Conclusion: This meta-analysis demonstrated that COPD is prevalent in IHD, involving 12.0% of IHD patients, and is linked to a lower prescription of BBs, an increased burden of comorbidities, and worse acute phase outcomes and long-term mortality.Keywords: ischemic heart disease, chronic obstructive pulmonary disease, prevalence, beta-blockers, outcomes