Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial

Mark T. Dransfield; Gerard J. Criner; David M.G. Halpin; Meilan K. Han; Benjamin Hartley; Ravi Kalhan; Peter Lange; David A. Lipson; Fernando J. Martinez; Dawn Midwinter; Dave Singh; Robert Wise; Ken M. Kunisaki

doi:10.1161/JAHA.121.024350

Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial

Mark T. Dransfield, Gerard J. Criner, David M.G. Halpin, Meilan K. Han, Benjamin Hartley, Ravi Kalhan, Peter Lange, David A. Lipson, Fernando J. Martinez, Dawn Midwinter, Dave Singh, Robert Wise, Ken M. Kunisaki

Medicine - Veteran's Administration Medical Center

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.

Original language	English (US)
Article number	e024350
Journal	Journal of the American Heart Association
Volume	11
Issue number	18
DOIs	https://doi.org/10.1161/JAHA.121.024350
State	Published - Sep 20 2022

Bibliographical note

Funding Information:
Other Contributions: Editorial support (in the form of writing assistance, including preparation of the initial draft under the direction and guidance of the authors, collating and incorporating authors’ comments for each draft, assembling tables and figures, grammatical editing and referencing) was provided by Ellen Barker, PhD, and Alexandra Berry, PhD, at Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GlaxoSmithKline.

Funding Information:
This study was funded by GSK (study number CTT116855; NCT02164513). The funders of the study had a role in the study design, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and the final responsibility to submit for publication. Ellipta is owned by or licensed to the GSK group of companies. Dave Singh is supported by the National Institute for Health Research Manchester Biomedical Research Centre.

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Keywords

LAMA/LABA
cardiovascular disease
chronic obstructive pulmonary disease
exacerbations
triple therapy

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access

10.1161/JAHA.121.024350

OpenUrl availability

Full text

Cite this

Dransfield, M. T., Criner, G. J., Halpin, D. M. G., Han, M. K., Hartley, B., Kalhan, R., Lange, P., Lipson, D. A., Martinez, F. J., Midwinter, D., Singh, D., Wise, R., & Kunisaki, K. M. (2022). Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial. Journal of the American Heart Association, 11(18), Article e024350. https://doi.org/10.1161/JAHA.121.024350

Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial. / Dransfield, Mark T.; Criner, Gerard J.; Halpin, David M.G. et al.
In: Journal of the American Heart Association, Vol. 11, No. 18, e024350, 20.09.2022.

Research output: Contribution to journal › Article › peer-review

Dransfield, MT, Criner, GJ, Halpin, DMG, Han, MK, Hartley, B, Kalhan, R, Lange, P, Lipson, DA, Martinez, FJ, Midwinter, D, Singh, D, Wise, R & Kunisaki, KM 2022, 'Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial', Journal of the American Heart Association, vol. 11, no. 18, e024350. https://doi.org/10.1161/JAHA.121.024350

@article{336696ec74694407a83c5da6eecefa51,

title = "Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial",

abstract = "BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.",

keywords = "LAMA/LABA, cardiovascular disease, chronic obstructive pulmonary disease, exacerbations, triple therapy",

author = "Dransfield, {Mark T.} and Criner, {Gerard J.} and Halpin, {David M.G.} and Han, {Meilan K.} and Benjamin Hartley and Ravi Kalhan and Peter Lange and Lipson, {David A.} and Martinez, {Fernando J.} and Dawn Midwinter and Dave Singh and Robert Wise and Kunisaki, {Ken M.}",

note = "Funding Information: Other Contributions: Editorial support (in the form of writing assistance, including preparation of the initial draft under the direction and guidance of the authors, collating and incorporating authors{\textquoteright} comments for each draft, assembling tables and figures, grammatical editing and referencing) was provided by Ellen Barker, PhD, and Alexandra Berry, PhD, at Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GlaxoSmithKline. Funding Information: This study was funded by GSK (study number CTT116855; NCT02164513). The funders of the study had a role in the study design, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and the final responsibility to submit for publication. Ellipta is owned by or licensed to the GSK group of companies. Dave Singh is supported by the National Institute for Health Research Manchester Biomedical Research Centre. Publisher Copyright: {\textcopyright} 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

year = "2022",

month = sep,

day = "20",

doi = "10.1161/JAHA.121.024350",

language = "English (US)",

volume = "11",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

number = "18",

}

TY - JOUR

T1 - Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease

T2 - Post Hoc Analysis From the IMPACT Trial

AU - Dransfield, Mark T.

AU - Criner, Gerard J.

AU - Halpin, David M.G.

AU - Han, Meilan K.

AU - Hartley, Benjamin

AU - Kalhan, Ravi

AU - Lange, Peter

AU - Lipson, David A.

AU - Martinez, Fernando J.

AU - Midwinter, Dawn

AU - Singh, Dave

AU - Wise, Robert

AU - Kunisaki, Ken M.

N1 - Funding Information: Other Contributions: Editorial support (in the form of writing assistance, including preparation of the initial draft under the direction and guidance of the authors, collating and incorporating authors’ comments for each draft, assembling tables and figures, grammatical editing and referencing) was provided by Ellen Barker, PhD, and Alexandra Berry, PhD, at Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GlaxoSmithKline. Funding Information: This study was funded by GSK (study number CTT116855; NCT02164513). The funders of the study had a role in the study design, data analysis, data interpretation, and writing of the report. The corresponding author had full access to all the data and the final responsibility to submit for publication. Ellipta is owned by or licensed to the GSK group of companies. Dave Singh is supported by the National Institute for Health Research Manchester Biomedical Research Centre. Publisher Copyright: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

PY - 2022/9/20

Y1 - 2022/9/20

N2 - BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.

AB - BACKGROUND: The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. METHODS AND RESULTS: This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 symptomatic patients with chronic obstructive pulmonary disease at risk of exacerbations) evaluated time-dependent risk of cardiovascular adverse events of special interest (CVAESI) following exacerbations and impact of exacerbation history, cardiovascular risk factors, and study treatment on this association. Risk (time-to-first) of CVAESI or CVAESI resulting in hospitalization or death was assessed during and 1 to 30, 31 to 90, and 91 to 365 days after resolution of moderate or severe exacerbations. CVAESI risk was compared between the period before and during/after exacerbation. CVAESI risk increased significantly during a moderate (hazard ratio [HR], 2.63 [95% CI, 2.08– 3.32]) or severe (HR, 21.84 [95% CI, 17.71– 26.93]) exacerbation and remained elevated for 30 days following an exacerbation (moderate: HR, 1.63 [95% CI, 1.28– 2.08]; severe: HR, 1.75 [95% CI, 0.99– 3.11; nonsignificant]) and decreased over time, returning to baseline by 90 days. Risk of CVAESI resulting in hospitalization or death also increased during an exacerbation (moderate: HR, 2.46 [95% CI, 1.53– 3.97]; severe: HR, 41.29 [95% CI, 30.43– 56.03]) and decreased in a similar time-dependent pattern. Results were consistent regardless of exacerbation history, cardiovascular risk at screening, or study treatment. CONCLUSIONS: Overall risk of cardiovascular events was higher during and in the 30 days following chronic obstructive pulmonary disease exacerbations, even among those with low cardiovascular risk, highlighting the need for exacerbation prevention and vigilance for cardiovascular events following exacerbations. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT02164513; Unique identifier: NCT02164513.

KW - LAMA/LABA

KW - cardiovascular disease

KW - chronic obstructive pulmonary disease

KW - exacerbations

KW - triple therapy

UR - http://www.scopus.com/inward/record.url?scp=85138360499&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85138360499&partnerID=8YFLogxK

U2 - 10.1161/JAHA.121.024350

DO - 10.1161/JAHA.121.024350

M3 - Article

C2 - 36102236

AN - SCOPUS:85138360499

SN - 2047-9980

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 18

M1 - e024350

ER -

Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Access

OpenUrl availability

Other files and links

Fingerprint

Cite this