Risk trajectory of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis

Abstract

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are known to increase the risk of cardiovascular (CV) events and mortality. However, the temporal trend of this risk has not fully elucidated. This systematic review and meta-analysis aims to quantify the risk of CV events after COPD exacerbations over different time periods. Objectives: To assess the temporal association between CV events, including acute coronary syndrome (ACS), heart failure (HF), acute cereberovascular events, arrhythmia and all-cause mortality after the onset of COPD exacerbations in the following timepoints: 1–30 and 31–180 days; 1–7, 8–14, 15–30, 31–180, 181–365 and >365 days. Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science and Cochrane databases, identifying observational studies that reported CV outcomes following COPD exacerbations. Studies were included if they enrolled adults diagnosed with COPD and compared CV event rates during exacerbation and non-exacerbation periods (PROSPERO, CRD42024561490). Results: Sixteen studies with over 1.8 million participants were included. Our meta-analysis demonstrated a significantly increased risk of ACS, HF, cerebrovascular events and arrhythmia, with the highest magnitude of risk observed in the period 1–30 days following an exacerbation. This increased risk showed a decline in time points 31–180, 181–365 days and remained persistently higher for ACS even one year after an acute exacerbation. Notably, the risk of HF was found to be greater compared to the other CV outcomes. Conclusion: COPD exacerbations significantly increase the risk of acute CV events, particularly within the first 30 days. Optimal strategies to reduce cardiopulmonary risk are needed.