Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop ventricular arrhythmia, a heart rhythm disorder affecting the heart’s lower chambers or ventricles, than people without the disease, according to a Taiwanese nationwide study.
Later analysis of that study also found that people with both COPD and asthma had an even higher risk of developing ventricular arrhythmia (VA).
The study, “Association between chronic obstructive pulmonary disease and ventricular arrhythmia: a nationwide population-based cohort study” was published in the journal Primary Care Respiratory Medicine.
COPD is associated with whole-body inflammation, which can trigger or aggravate heart problems.
Previous studies have reported an association between COPD exacerbations, or sudden episodes of disease worsening, and heart rhythm disorders, including VA. Yet, the exact risk for VA in COPD patients remains unclear.
To better estimate that risk, a group of researchers in Taiwan now analyzed 11-year data, collected from 2001 to 2012, from the National Health Insurance Research Database.
In total, the analysis included 71,838 COPD patients — with a mean age of 57.66 years and including 54% men — and 71,838 age- and sex-matched individuals who did not have COPD and served as controls.
At the start of the study (baseline) and compared with the control group, the COPD patients had a significantly higher prevalence of heart-related conditions, including heart failure, acute myocardial infarction (heart attack), stroke, ischemic heart disease, and peripheral vascular disease.
High blood pressure, diabetes, and kidney failure also were more prevalent among those with COPD.
Aspirin, statins or cholesterol-lowering medicines, and renin-angiotensin-aldosterone system inhibitors, which are commonly prescribed to lower blood pressure, were more frequently used by COPD patients than the healthy controls.
In addition, antiarrhythmic drugs (AADs), which are used to normalize heart rhythm, were more commonly prescribed to people with COPD than healthy controls. In particular, COPD patients were more likely than their healthy counterparts to be prescribed class 2 AADs that include conventional beta blockers (27.10% vs. 20.81%).
During follow-up, people with COPD were found to be 1.45 times more likely to develop VA than controls. This increased risk for VA among those with COPD was independent of other simultaneous medical conditions, type of medications used, or monthly income.
The researchers also found the risk for VA increased following hospitalizations or emergency visits due to acute COPD exacerbations. According to adjusted data, after a first hospitalization/visit, the risk for VA increased 1.28 times. After a second visit, it was 1.75 times higher. Patients who needed a third visit saw their risk increase to one that was 1.88 times higher than an individual without any hospitalizations..
Moreover, the results showed that young to middle-aged patients — those ages 20–64 — had a higher VA incidence rate due to exacerbations that increased with a higher number of hospitalizations or emergency visits. Likewise, men with COPD also had a higher incidence of VA compared with women.
Patients who were never hospitalized or visited the emergency department due to COPD flare-ups were found to have a risk of VA that was similar to that of those in the control group. An exception was seen for those who had a history of diabetes and kidney failure, whose risk of developing VA was more than twice that of controls.
Additional analyses revealed that patients who had both asthma and COPD were 1.49 times more likely to develop VA than those who only had COPD.
Moreover, investigators found that COPD patients who were prescribed AADs had a two to six times higher risk of developing VA.
Yet, those who were being treated with inhaled medications to improve breathing and prevent asthma-like symptoms were not found to be at a higher risk of developing VA. These medications included short-acting beta-agonists (SABAs), long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhalation corticosteroids (ICSs), or LABA–ICS combination therapy.
Overall, “in the present nationwide population-based cohort study, the presence of COPD, acute COPD exacerbation, and airway disease complexity were positively associated with VA risk,” the researchers wrote.
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