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Excess risk of major vascular diseases associated with airflow obstruction: a 9-year prospective study of 0.5 million Chinese adults

Authors Kurmi OP, Li L, Davis KJ, Wang J, Bennett DA, Chan KH, Yang L, Chen Y, Guo Y, Bian Z, Chen J, Wei L, Jin D, Collins R, Peto R, Chen Z

Received 10 October 2017

Accepted for publication 7 December 2017

Published 8 March 2018 Volume 2018:13 Pages 855—865


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Om P Kurmi,1 Liming Li,2 Kourtney J Davis,3 Jenny Wang,1 Derrick A Bennett,1 Ka Hung Chan,1 Ling Yang,1 Yiping Chen,1 Yu Guo,4 Zheng Bian,4 Junshi Chen,5 Liuping Wei,6 Donghui Jin,7 Rory Collins,1 Richard Peto,1 Zhengming Chen1

On behalf of the China Kadoorie Biobank collaborative group

1Clinical Trial Service and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 2Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China; 3Real World Evidence and Epidemiology, GlaxoSmithKline, Collegeville, PA, USA; 4Chinese Academy of Medical Sciences, Beijing China; 5China National Center for Food Safety Risk Assessment, Beijing, China; 6NCDs Prevention and Control Department, Liuzhou CDC, Liuzhou, China; 7NCDs Prevention and Control Department, Hunan CDC, Changsha, China

Background: China has high COPD rates, even among never-regular smokers. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults.
Objective: We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality.
Materials and methods: In 2004–2008, a nationwide prospective cohort study recruited 512,891 men and women aged 30–79 years from 10 diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalization for 9 years. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without.
Results: Of 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21–1.36). There were also increased risks of hemorrhagic stroke (n=823, HR 1.18, 95% CI 1.09–1.27), major coronary events (n=635, HR 1.33, 95% CI 1.22–1.45), and heart failure (n=543, HR 2.19, 95% CI 1.98–2.41). For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers.
Conclusion: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis.

Keywords: chronic obstructive pulmonary disease, exacerbation, vascular diseases, cohort, China

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