The Associations and Outcomes of Chronic Obstructive Pulmonary Disease Patients with Cardiovascular Disease

Abstract

Abstract Background: Chronic obstructive pulmonary disease (COPD) frequently coexists with cardiovascular disease (CVD), sharing common risk factors such as smoking, ageing, and systemic inflammation. The presence of CVD in COPD patients has been associated with increased morbidity and mortality. Although the link between COPD and cardiovascular disease has been studied previously, analyses leveraging large-scale, clinically rich datasets remain limited. Objectives: This study aimed to assess the associations between CVD comorbidity and clinical outcomes among COPD patients. Specifically, it compared demographic and clinical characteristics, spirometry results, and mortality outcomes between a cohort of patients with COPD (COPD-only) and a cohort with COPD and cardiovascular disease (COPD+CVD). It also identified independent predictors of mortality using multivariable modelling. Methods: A retrospective cohort analysis was conducted using international data from the 3CIA (International COPD cohorts investigating the associations) dataset, a global collaboration comprising 5,224 spirometry-confirmed COPD patients. Of these, 1,441 patients (27.6%) had coexisting CVD. Baseline characteristics were compared using the Mann–Whitney U and Chi-square tests. Logistic regression and Cox proportional hazards models were used to determine predictors of all-cause mortality. Results: In comparison to the COPD-only group, patients with COPD+CVD were significantly older (median 68 vs. 63 years, p < 0.001), had lower FEV₁% predicted (median 55.3% vs. 61.5%, p < 0.001), and were likely to be male (74.0% vs. 66.2%, p < 0.001). The all-cause mortality rate was higher in the COPD+CVD group (17.5%) compared to the COPD-only group (10.8%). Multivariable regression revealed that age, male sex, reduced FEV₁%, and CVD comorbidity were all independently associated with increased mortality risk. i Discussion: COPD patients with coexisting cardiovascular disease had worse outcomes than those with COPD alone, with higher mortality and poorer lung function. The excess risk was not explained by smoking or body mass index (BMI), but persisted after accounting for age, sex, and baseline respiratory status. Moreover, findings indicate that CVD adds an independent burden in COPD, commonly through overlapping mechanisms such as inflammation. Additionally, the survival gap observed between groups underestimates the need for earlier recognition and closer management of cardiovascular risk in this population. Conclusion: Cardiovascular comorbidity is the strongest predictor of mortality in COPD, independent of lung function, age, sex, BMI, and smoking. Patients who have COPD and cardiovascular comorbidity are at higher risk and likely would benefit from earlier and more careful follow-up. Traditional risk factors, such as smoking and BMI, seemed to influence outcomes mainly through cardiovascular pathways rather than acting independently. These results underline the importance of routine cardiovascular assessment in COPD management, which also suggests that future research should include longer follow-up and cause-specific mortality data to improve prognostic models and help guide targeted interventions.