Coronary heart disease and heart failure in asthma, COPD, and asthma-COPD overlap

Introduction: We investigated risk of coronary heart disease and heart failure in phenotypes of obstructive airway disease. Methods: Among 91,692 participants in the Copenhagen General Population Study, 42,058 individuals were classified with no respiratory disease, and 11,988 individuals had different phenotypes of obstructive airways disease: asthma with early or late onset, Chronic Obstructive Pulmonary Disease (COPD) with forced expiratory volume in one second (FEV1) above or below 50% of predicted value (%p), or asthma-COPD overlap. Results: During a mean follow-up of 5.7 years we registered 3,584 admissions for coronary heart disease and 1,590 admissions for heart failure. Multivariable Cox regression analyses of time to first admission were used with a two-sided p-value of 0.05 as significance level. Compared to no respiratory disease the highest risks of coronary heart disease and heart failure were observed in asthma-COPD overlap with late-onset asthma and FEV1<50%p, hazard ratio (HR)=2.2 (95% confidence interval (95% CI): 1.6-3.0), and HR=2.9 (95% CI: 2.0-4.3), respectively. In COPD with FEV1 above 50%p the hazard ratios were 1.3 (95% CI: 1.2-1.5) for coronary heart disease and 1.9 (95% CI: 1.6-2.3) for heart failure. Asthma associated with increased risks of coronary heart disease and heart failure, however, in asthma without allergy the hazard ratio was 1.1 (95% CI: 0.7-1.6) for coronary heart disease while individuals with allergy had a hazard ratio of 1.4 (95% CI: 1.1-1.6). Conclusions: Risks of coronary heart disease and heart failure were increased in asthma, COPD and asthma-COPD overlap. In asthma, the risk of coronary heart disease depended on presence of allergy. We suggest that cardiovascular risk factors should be assessed systematically in individuals with obstructive airway disease with the potential to facilitate targeted treatments.