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Published in: BMC Pulmonary Medicine 1/2015

Open Access 01-12-2015 | Research article

Ischemic heart disease among subjects with and without chronic obstructive pulmonary disease – ECG-findings in a population-based cohort study

Authors: Ulf Nilsson, Bengt Johansson, Berne Eriksson, Anders Blomberg, Bo Lundbäck, Anne Lindberg

Published in: BMC Pulmonary Medicine | Issue 1/2015

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Abstract

Background

Cardiovascular comorbidity in COPD is common and contributes to increased mortality. A few population-based studies indicate that ischemic electrocardiogram (ECG)-changes are more prevalent in COPD, while others do not. The aim of the present study was to estimate the presence of ischemic heart disease (IHD) in a population-based COPD-cohort in comparison with subjects without COPD.

Methods

All subjects with obstructive lung function (COPD, n = 993) were identified together with age- and sex-matched controls (non-COPD, n = 993) from population-based cohorts examined in 2002–04. In 2005, data from structured interview, spirometry and ECG were collected from 1625 subjects. COPD was classified into GOLD 1–4 after post-bronchodilator spirometry. Ischemic ECG-changes, based on Minnesota-coding, were classified according to the Whitehall criteria into probable and possible IHD.

Results

Self-reported IHD was equally common in COPD and non-COPD, and so were probable and possible ischemic ECG-changes according to Whitehall. After excluding subjects with restrictive spirometric pattern from the non-COPD-group, similar comparison with regard to presence of IHD performed between those with COPD and those with normal lung-function did neither show any differences. There was a significant association between self-reported IHD (p = 0.007) as well as probable ischemic ECG-changes (p = 0.042), and increasing GOLD stage. In COPD there was a significant association between level of FEV1 percent of predicted and self-reported as well as probable ischemic ECG-changes, and this association persisted for self-reported IHD also after adjustment for sex and age.

Conclusion

In this population-based study, self-reported IHD and probable ischemic ECG-changes were associated with COPD disease severity assessed by spirometry.
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Literature
1.
go back to reference Lindberg A, Bjerg A, Bjerg-Bäcklund A, Rönmark E, Larsson LG, Lundbäck B. Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med. 2006;100(2):264–72.CrossRefPubMed Lindberg A, Bjerg A, Bjerg-Bäcklund A, Rönmark E, Larsson LG, Lundbäck B. Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med. 2006;100(2):264–72.CrossRefPubMed
2.
go back to reference Soriano JB, Ancochea J, Miravitlles M, García-Río F, Duran-Tauleria E, Muñoz L, et al. Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007. Eur Respir J. 2010;36(4):758–65.CrossRefPubMed Soriano JB, Ancochea J, Miravitlles M, García-Río F, Duran-Tauleria E, Muñoz L, et al. Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007. Eur Respir J. 2010;36(4):758–65.CrossRefPubMed
3.
go back to reference Gershon AS, Wang C, Wilton AS, Raut R, To T. Trends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in ontario, Canada, 1996 to 2007: a population-based study. Arch Intern Med. 2010;170(6):560–5.CrossRefPubMed Gershon AS, Wang C, Wilton AS, Raut R, To T. Trends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in ontario, Canada, 1996 to 2007: a population-based study. Arch Intern Med. 2010;170(6):560–5.CrossRefPubMed
4.
go back to reference Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337–49.PubMedCentralCrossRefPubMed Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337–49.PubMedCentralCrossRefPubMed
5.
go back to reference WHO: GLOBAL STATUS REPORTon noncommunicable diseases 2014. In.; 2014. WHO: GLOBAL STATUS REPORTon noncommunicable diseases 2014. In.; 2014.
6.
go back to reference Lindberg A, Larsson LG, Muellerova H, Ronmark E, Lundback B. Up-to-date on mortality in COPD - report from the OLIN COPD study. BMC Pulm Med. 2012;12:1.PubMedCentralCrossRefPubMed Lindberg A, Larsson LG, Muellerova H, Ronmark E, Lundback B. Up-to-date on mortality in COPD - report from the OLIN COPD study. BMC Pulm Med. 2012;12:1.PubMedCentralCrossRefPubMed
7.
go back to reference Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, et al. COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5(4):235–56.CrossRefPubMed Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, et al. COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5(4):235–56.CrossRefPubMed
8.
go back to reference Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. In: Lancet. 379th ed. England: 2012 Elsevier Ltd; 2012. p. 1341–51. Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. In: Lancet. 379th ed. England: 2012 Elsevier Ltd; 2012. p. 1341–51.
9.
go back to reference Ukena C, Mahfoud F, Kindermann M, Kindermann I, Bals R, Voors AA, et al. The cardiopulmonary continuum systemic inflammation as ‘common soil’ of heart and lung disease. Int J Cardiol. 2010;145(2):172–6.CrossRefPubMed Ukena C, Mahfoud F, Kindermann M, Kindermann I, Bals R, Voors AA, et al. The cardiopulmonary continuum systemic inflammation as ‘common soil’ of heart and lung disease. Int J Cardiol. 2010;145(2):172–6.CrossRefPubMed
10.
go back to reference Cavailles A, Brinchault-Rabin G, Dixmier A, Goupil F, Gut-Gobert C, Marchand-Adam S, et al. Comorbidities of COPD. European respiratory review : an official journal of the European Respiratory Society. 2013;22(130):454–75.CrossRef Cavailles A, Brinchault-Rabin G, Dixmier A, Goupil F, Gut-Gobert C, Marchand-Adam S, et al. Comorbidities of COPD. European respiratory review : an official journal of the European Respiratory Society. 2013;22(130):454–75.CrossRef
11.
go back to reference Mapel DW, Dedrick D, Davis K. Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991–1999. COPD. 2005;2(1):35–41.CrossRefPubMed Mapel DW, Dedrick D, Davis K. Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991–1999. COPD. 2005;2(1):35–41.CrossRefPubMed
12.
go back to reference de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM, Bellon-Cano JM, Ancochea-Bermudez J, Calle-Rubio M, et al. Cardiovascular risk factors in chronic obstructive pulmonary disease: results of the ARCE study. Arch Bronconeumol. 2008;44(5):233–8.PubMed de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM, Bellon-Cano JM, Ancochea-Bermudez J, Calle-Rubio M, et al. Cardiovascular risk factors in chronic obstructive pulmonary disease: results of the ARCE study. Arch Bronconeumol. 2008;44(5):233–8.PubMed
13.
go back to reference Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol. 2007;99(5):636–41.CrossRefPubMed Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol. 2007;99(5):636–41.CrossRefPubMed
14.
go back to reference Campo G, Guastaroba P, Marzocchi A, Santarelli A, Varani E, Vignali L, et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest. 2013;144(3):750–7.CrossRefPubMed Campo G, Guastaroba P, Marzocchi A, Santarelli A, Varani E, Vignali L, et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest. 2013;144(3):750–7.CrossRefPubMed
15.
go back to reference Engstrom G, Hedblad B, Janzon L. Reduced lung function predicts increased fatality in future cardiac events. A population-based study. J Intern Med. 2006;260(6):560–7.CrossRefPubMed Engstrom G, Hedblad B, Janzon L. Reduced lung function predicts increased fatality in future cardiac events. A population-based study. J Intern Med. 2006;260(6):560–7.CrossRefPubMed
16.
go back to reference Campo G, Pavasini R, Malagu M, Mascetti S, Biscaglia S, Ceconi C, et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther. 2015;29(2):147–57.CrossRefPubMed Campo G, Pavasini R, Malagu M, Mascetti S, Biscaglia S, Ceconi C, et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther. 2015;29(2):147–57.CrossRefPubMed
17.
go back to reference Lindberg A, Lundbäck B. The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality. Clin Respir J. 2008;2 Suppl 1:64–71.CrossRefPubMed Lindberg A, Lundbäck B. The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality. Clin Respir J. 2008;2 Suppl 1:64–71.CrossRefPubMed
18.
go back to reference Jyrki-Tapani K, Sovijarvi A, Lundback B. Chronic obstructive pulmonary disease in Finland: prevalence and risk factors. COPD. 2005;2(3):331–9.CrossRefPubMed Jyrki-Tapani K, Sovijarvi A, Lundback B. Chronic obstructive pulmonary disease in Finland: prevalence and risk factors. COPD. 2005;2(3):331–9.CrossRefPubMed
19.
go back to reference Lundback B, Stjernberg N, Rosenhall L, Lindstrom M, Jonsson E, Andersson S. Methacholine reactivity and asthma. Report from the Northern Sweden Obstructive Lung Disease Project. Allergy. 1993;48(2):117–24.CrossRefPubMed Lundback B, Stjernberg N, Rosenhall L, Lindstrom M, Jonsson E, Andersson S. Methacholine reactivity and asthma. Report from the Northern Sweden Obstructive Lung Disease Project. Allergy. 1993;48(2):117–24.CrossRefPubMed
20.
go back to reference Lundback B, Stjernberg N, Nystrom L, Forsberg B, Lindstrom M, Lundback K, et al. Epidemiology of respiratory symptoms, lung function and important determinants. Report from the Obstructive Lung Disease in Northern Sweden Project. Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 1994;75(2):116–26.CrossRef Lundback B, Stjernberg N, Nystrom L, Forsberg B, Lindstrom M, Lundback K, et al. Epidemiology of respiratory symptoms, lung function and important determinants. Report from the Obstructive Lung Disease in Northern Sweden Project. Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 1994;75(2):116–26.CrossRef
21.
go back to reference Lundback B, Ronmark E, Jonsson E, Larsson K, Sandstrom T. Incidence of physician-diagnosed asthma in adults--a real incidence or a result of increased awareness? Report from The Obstructive Lung Disease in Northern Sweden Studies. Respir Med. 2001;95(8):685–92.CrossRefPubMed Lundback B, Ronmark E, Jonsson E, Larsson K, Sandstrom T. Incidence of physician-diagnosed asthma in adults--a real incidence or a result of increased awareness? Report from The Obstructive Lung Disease in Northern Sweden Studies. Respir Med. 2001;95(8):685–92.CrossRefPubMed
22.
go back to reference Reid DD, Hamilton PJ, McCartney P, Rose G, Jarrett RJ, Keen H. Smoking and other risk factors for coronary heart-disease in British civil servants. Lancet. 1976;2(7993):979–84.CrossRefPubMed Reid DD, Hamilton PJ, McCartney P, Rose G, Jarrett RJ, Keen H. Smoking and other risk factors for coronary heart-disease in British civil servants. Lancet. 1976;2(7993):979–84.CrossRefPubMed
23.
go back to reference American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med. 1995;152(3):1107–1136.CrossRef American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med. 1995;152(3):1107–1136.CrossRef
24.
go back to reference From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Available from: [http://www.goldcopd.org]. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Available from: [http://​www.​goldcopd.​org].
25.
go back to reference Backman H, Lindberg A, Sovijärvi A, Larsson K, Lundbäck B, Rönmark E. Evaluation of the global lung function initiative 2012 reference values for spirometry in a Swedish population sample. BMC Pulm Med. 2015;15(1):26.PubMedCentralCrossRefPubMed Backman H, Lindberg A, Sovijärvi A, Larsson K, Lundbäck B, Rönmark E. Evaluation of the global lung function initiative 2012 reference values for spirometry in a Swedish population sample. BMC Pulm Med. 2015;15(1):26.PubMedCentralCrossRefPubMed
26.
go back to reference Backman H, Lindberg A, Odén A, Ekerljung L, Hedman L, Kainu A, et al. Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies. Eur Clin Respir J. 2015;2:26375.CrossRef Backman H, Lindberg A, Odén A, Ekerljung L, Hedman L, Kainu A, et al. Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies. Eur Clin Respir J. 2015;2:26375.CrossRef
27.
go back to reference Mullerova H, Agusti A, Erqou S, Mapel DW. Cardiovascular Comorbidity in COPD Systematic Literature Review. Chest. 2013;144(4):1163–78.CrossRefPubMed Mullerova H, Agusti A, Erqou S, Mapel DW. Cardiovascular Comorbidity in COPD Systematic Literature Review. Chest. 2013;144(4):1163–78.CrossRefPubMed
28.
go back to reference Lange P, Mogelvang R, Marott JL, Vestbo J, Jensen JS. Cardiovascular morbidity in COPD: A study of the general population. COPD. 2010;7(1):5–10.CrossRefPubMed Lange P, Mogelvang R, Marott JL, Vestbo J, Jensen JS. Cardiovascular morbidity in COPD: A study of the general population. COPD. 2010;7(1):5–10.CrossRefPubMed
29.
go back to reference Johannessen A, Omenaas ER, Bakke PS, Gulsvik A. Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: a community study. Thorax. 2005;60(10):842–7.PubMedCentralCrossRefPubMed Johannessen A, Omenaas ER, Bakke PS, Gulsvik A. Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: a community study. Thorax. 2005;60(10):842–7.PubMedCentralCrossRefPubMed
30.
go back to reference Methvin JN, Mannino DM, Casey BR. COPD prevalence in southeastern Kentucky: the burden of lung disease study. Chest. 2009;135(1):102–7.CrossRefPubMed Methvin JN, Mannino DM, Casey BR. COPD prevalence in southeastern Kentucky: the burden of lung disease study. Chest. 2009;135(1):102–7.CrossRefPubMed
31.
go back to reference Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003;58(5):388–93.PubMedCentralCrossRefPubMed Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003;58(5):388–93.PubMedCentralCrossRefPubMed
32.
go back to reference Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring Jr E, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16(1):63–70.CrossRefPubMed Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring Jr E, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16(1):63–70.CrossRefPubMed
33.
go back to reference Maclay JD, McAllister DA, Mills NL, Paterson FP, Ludlam CA, Drost EM, et al. Vascular dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;180(6):513–20.CrossRefPubMed Maclay JD, McAllister DA, Mills NL, Paterson FP, Ludlam CA, Drost EM, et al. Vascular dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;180(6):513–20.CrossRefPubMed
34.
go back to reference Vivodtzev I, Tamisier R, Baguet JP, Borel JC, Levy P, Pepin JL. Arterial stiffness in COPD. Chest. 2014;145(4):861–75.CrossRefPubMed Vivodtzev I, Tamisier R, Baguet JP, Borel JC, Levy P, Pepin JL. Arterial stiffness in COPD. Chest. 2014;145(4):861–75.CrossRefPubMed
35.
go back to reference Qvist L, Nilsson U, Johansson V, Larsson K, Rönmark E, Langrish J, et al. Central arterial stiffness is increased among subjects with severe and very severe COPD - report from a population based cohort-study. Eur Clin Respir J. 2015;2:27023.CrossRef Qvist L, Nilsson U, Johansson V, Larsson K, Rönmark E, Langrish J, et al. Central arterial stiffness is increased among subjects with severe and very severe COPD - report from a population based cohort-study. Eur Clin Respir J. 2015;2:27023.CrossRef
36.
go back to reference Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention. Thorax. 2014;69(1):80–1.CrossRefPubMed Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention. Thorax. 2014;69(1):80–1.CrossRefPubMed
37.
go back to reference Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, Bakke P, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med. 2011;365(13):1184–92.CrossRefPubMed Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, Bakke P, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med. 2011;365(13):1184–92.CrossRefPubMed
38.
go back to reference Eriksson B, Lindberg A, Mullerova H, Ronmark E, Lundback B. Association of heart diseases with COPD and restrictive lung function--results from a population survey. Respir Med. 2013;107(1):98–106.CrossRefPubMed Eriksson B, Lindberg A, Mullerova H, Ronmark E, Lundback B. Association of heart diseases with COPD and restrictive lung function--results from a population survey. Respir Med. 2013;107(1):98–106.CrossRefPubMed
39.
go back to reference Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ. Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol. 2004;57(10):1096–103.CrossRefPubMed Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ. Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol. 2004;57(10):1096–103.CrossRefPubMed
40.
go back to reference Shah A, Wagner GS, Green CL, Crater SW, Sawchak ST, Wildermann NM, et al. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. Am J Cardiol. 1997;80(4):512–3.CrossRefPubMed Shah A, Wagner GS, Green CL, Crater SW, Sawchak ST, Wildermann NM, et al. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. Am J Cardiol. 1997;80(4):512–3.CrossRefPubMed
41.
go back to reference Michael MA, El Masry H, Khan BR, Das MK. Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50(3):198–208.CrossRefPubMed Michael MA, El Masry H, Khan BR, Das MK. Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis. 2007;50(3):198–208.CrossRefPubMed
42.
go back to reference Celli BR, MacNee W, Force AET. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2004;23(6):932–46.CrossRef Celli BR, MacNee W, Force AET. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2004;23(6):932–46.CrossRef
Metadata
Title
Ischemic heart disease among subjects with and without chronic obstructive pulmonary disease – ECG-findings in a population-based cohort study
Authors
Ulf Nilsson
Bengt Johansson
Berne Eriksson
Anders Blomberg
Bo Lundbäck
Anne Lindberg
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2015
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-015-0149-1

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