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Increased risk of peripheral arterial occlusive diseases in patients with chronic obstructive pulmonary disease: a nationwide study in Taiwan

Authors Liao KM, Kuo LT, Lu HY

Received 18 January 2019

Accepted for publication 5 June 2019

Published 4 July 2019 Volume 2019:14 Pages 1455—1464


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 5

Editor who approved publication: Prof. Dr. Chunxue Bai

Kuang-Ming Liao,1 Lu-Ting Kuo,2 Hsueh-Yi Lu3

1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; 3Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan

Objective: Chronic obstructive pulmonary disease (COPD) is associated with atherosclerosis. Previous studies including limited sample sizes have shown the prevalence of peripheral arterial occlusive disease (PAOD) among COPD patients. We sought to investigate the incidence of PAOD among COPD patients in Taiwan using a national database.
Methods: COPD patients were collected from the National Health Insurance Research Database of Taiwan from 1996 to 2010. The COPD cohort was propensity score matched according to age, sex, and comorbidities of atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease to patients without COPD (the control cohort). We evaluated the incidence of PAOD in COPD patients and the risk of PAOD associated with atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accidents, and chronic liver disease.
Results: The study included 51,869 COPD patients and 51,869 control patients without COPD. The incidence of PAOD was 1.23-fold higher (95% confidence interval [CI]  =1.17–1.29) in the COPD group than in the non-COPD group. Moreover, COPD and atrial fibrillation alone (adjusted hazard ratio (aHR) 2.99; P=0.001), hypertension alone (aHR, 2.05; P<0.001), diabetes alone (aHR, 2.62; P<0.001) and cerebrovascular accidents alone (aHR 2.05; P<0.001), increased the risk of developing PAOD. The significant aHRs increased (from 3.7 to 4.9) when the number of comorbidities increased (from ≥1 to ≥3 comorbidities).
Conclusion: COPD patients have a higher incidence and an independently higher risk of PAOD than patients without COPD. The risk of PAOD is markedly elevated in COPD patients with more comorbidities.

Keywords: chronic obstructive pulmonary disease, incidence, peripheral arterial occlusive disease

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