(Press-News.org) ATS 2015, DENVER -- Chronic obstructive pulmonary disease, or COPD, is associated with increased risk of dying from a cardiovascular disease such as heart failure or a heart attack, as well as diseases not associated with the heart. However, COPD is not by itself associated with increased likelihood of having a stroke or a systemic embolism, according to a new research study.
Researchers from Duke University and the Mayo Clinic reached this conclusion after analyzing data from a large randomized trial of patients with atrial fibrillation, a condition that produces an irregular heartbeat. The trial, ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation), compared the effectiveness of two anticoagulants--apixaban and warfarin--on reducing the risk of stroke or systemic embolism in these patients. A systemic embolism occurs when a clot formed in the heart travels to another part of the body and blocks blood flow; typically, this blockage occurs in the brain, causing a stroke, but systemic emboli can also travel to other organs or a person's extremities.
The researchers examined the data from the 18,206 patients, all with atrial fibrillation, enrolled in ARISTOTLE to explore the connection between COPD and stroke in this patient population. The researchers will present their data during ATS 2015 in Denver, May 15 to 20.
"Other studies have shown that COPD is an independent risk factor for cardiovascular disease, but what hadn't been studied was whether COPD was an independent risk factor for stroke, specifically among patients with atrial fibrillation," said Michael Durheim, MD, a pulmonary and critical care fellow at Duke. Atrial fibrillation is itself a known risk factor for stroke and systemic embolism because clots more easily form when blood is pumped irregularly by the heart.
In their analysis, Dr. Durheim and his colleagues found that COPD was present in 1,950 (10.8%) of the 18,134 patients for whom pulmonary disease history was available. Patients with COPD were older, more often men and more likely to be current or former smokers. They were also more likely to suffer from other diseases that would put them at higher risk for stroke, including coronary artery disease, a prior heart attack and heart failure.
After adjusting for these and other patient characteristics, COPD was not associated with increased risk of stroke or systemic embolism (adjusted HR 0.86 [95% CI 0.61, 1.21], p = 0.382). However, COPD was associated with increased mortality from all causes by 54 percent (adjusted HR 1.54 [95% CI 1.31, 1.82], p < 0.001), including both cardiovascular and non-cardiovascular death.
Dr. Durheim says that because COPD independently raises mortality in patients with atrial fibrillation, further studies are warranted to "elucidate the mechanisms" by which COPD contributes to increased mortality. The results of those studies, he adds, might change clinical practice.
Meanwhile, he notes one practical outcome of his study: the effect of apixaban compared with warfarin on stroke or systemic embolism did not differ between subjects with and without COPD (HR 0.92 vs 0.78, interaction p = 0.617). "The presence of COPD doesn't need to affect provider's choice of an anticoagulant," he says.
INFORMATION:
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Abstract 65465
Chronic Obstructive Pulmonary Disease is Associated with Increased Risk of Mortality Among Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial
Type:
Scientific Abstract
Category:
09.03 - COPD: Comorbidities (CP)
Authors:
M.T. Durheim1, D.D. Cyr1, S.M. Al-Khatib1, L.E. Thomas1, R.D. Lopes1, B.J. Gersh2, S.M. Palmer1, C.B. Granger1; 1Duke Clinical Research Institute - Durham, NC/US, 2Mayo Clinic - Rochester, MN/US
Abstract Body
Rationale: Comorbid chronic obstructive pulmonary disease (COPD) is associated with poor outcomes among patients with cardiovascular disease. The risk of stroke or mortality associated with COPD among patients with atrial fibrillation is not well understood. The objective of this study was to determine the risk of stroke or systemic embolism, all-cause mortality, and cardiovascular mortality associated with COPD among patients with atrial fibrillation and examine whether the effect of apixaban varies by presence of COPD.
Methods: We analyzed patients from ARISTOTLE, a randomized trial of 18,206 patients with atrial fibrillation comparing the effects of apixaban and warfarin on risk of stroke or systemic embolism and bleeding events. The association between COPD (as identified in the medical record) and risk of stroke or systemic embolism and mortality, adjusting for treatment allocation, smoking history and other risk factors, was assessed using Cox proportional hazards regression.
Results: COPD was present in 1950 (10.8%) of 18,134 patients for whom pulmonary disease history was available. Patients with COPD were older, more likely to be male and current or former smokers, with increased burden of comorbidities. In particular, COPD was associated with higher CHADS2 score and increased burden of cardiovascular disease, including coronary artery disease, prior myocardial infarction and heart failure (all p < 0.001). As shown in the Table, after adjusting for these and other patient characteristics, COPD was not associated with risk of stroke or systemic embolism (adjusted HR 0.86 [95% CI 0.61, 1.21], p = 0.382). However, COPD was associated with a higher risk of all-cause mortality (adjusted HR 1.54 [95% CI 1.31, 1.82], p < 0.001). When cause-specific mortality was considered, COPD remained associated with a higher risk of both cardiovascular and non-cardiovascular death. The effect of apixaban compared with warfarin on stroke or systemic embolism did not differ between subjects with and without COPD (HR 0.92 vs 0.78, interaction p = 0.617).
Conclusions: In patients with atrial fibrillation, COPD is associated with increased risk of cardiovascular and non-cardiovascular mortality. Future studies should explore mechanisms by which COPD impacts cardiovascular outcomes beyond the effects of shared risk factors.
MINNEAPOLIS - People with depression may be more likely to develop Parkinson's disease, according to a large study published in the May 20, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"We saw this link between depression and Parkinson's disease during over a timespan of more than two decades, so depression may be a very early symptom of Parkinson's disease or a risk factor for the disease," said study author Peter Nordström, PhD, at Umeå University in Umeå, Sweden.
The researchers also examined siblings, ...
DALLAS, May 20, 2015 -- Group behavioral therapy that encouraged walking at home significantly improved and prevented mobility loss among patients with clogged arteries in the legs, according to research in the Journal of the American Heart Association.
Known as peripheral artery disease (PAD), clogged arteries in the legs can cause pain and fatigue while walking. Maintaining mobility is integral to preserving functional independence, social interactions and daily activities.
Although studies have shown that supervised exercise on a treadmill improves walking endurance ...
DALLAS, May 20, 2015 -- Large waistline, cholesterol disorders and other metabolic abnormalities may increase the risk of cardiovascular disease more among black women than among white women, according to new research in Journal of the American Heart Association.
Previous studies have focused primarily on white participants and found that obesity without a clustering of at least three metabolic disorders (metabolic syndrome) was not associated with increased cardiovascular disease risk. The metabolic abnormalities included in the definition of the metabolic syndrome are ...
WEST LAFAYETTE, Ind. - Purdue University research shows that a small amount of nicotinoid pesticide substantially weakens termites' ability to fight off fungal diseases, a finding that could lead to more effective methods of pest control.
The study also provides clues into termites' robust defense systems and how nicotinoids affect social insects.
A team led by Michael Scharf, the O.W. Rollins/Orkin Chair and professor of entomology, found that a sublethal dose of imidacloprid knocked out key microbes in the termite gut and suppressed the social hygiene habits that ...
Rolf Mueller, an associate professor of mechanical engineering in the College of Engineering at Virginia Tech, has developed a prototype of a dynamic sonar system inspired by horseshoe bats.
The prototype was presented Wednesday (May 20) at the Acoustical Society of America meeting in Pittsburgh, Pennsylvania. The principles used in its design could eventually lead to sonar systems much more effective than the best arrays available today.
Because bats use a form of biological sonar called echolocation to navigate and hunt in the dark, they are natural models for man-made ...
Paris, France - May 20, 2015 - Data from the ILUMIEN II trial found that guidance from optimal coherence tomography (OCT) was associated with comparable stent expansion as guidance from intravascular ultrasound (IVUS) in patients undergoing percutaneous coronary intervention (PCI). Results from the study were presented today at EuroPCR 2015, the official annual meeting of the European Association for Percutaneous Cardiovascular Interventions.
Coronary stents must be optimally deployed with full lesion coverage and complete stent expansion to optimize outcomes. Less than ...
When it comes to keeping online information safe from hackers and other criminals, it's up to the individual user to keep his or her data secure.
Unfortunately, many Internet users don't take that responsibility seriously, thinking that's the job of the Internet provider or even the company that manufactured their computer.
The end-user is often the "weakest link" in the Internet safety chain, said Saleem Alhabash, a Michigan State University faculty member who is part of a team that researches ways of making the Web safer for its users.
The team's conclusion: Internet ...
A common mutation in a gene that regulates cholesterol levels may raise the risk of heart disease in carriers, according to a new UConn Health study.
Researchers examined a mutation called the missense rs4238001 variant, which alters the type of protein made by the gene SCARB1, and thereby the body's cholesterol regulation.
The study, led by Annabelle Rodriguez-Oquendo, an endocrinologist at UConn Health, was based on information about more than 5,000 people who participated in the Multi-Ethnic Study of Artherosclerosis in major American cities from 2000 to 2002. ...
The fossils of the first dinosaur fossil from Washington State were collected along the shores of Sucia Island State Park in the San Juan Islands, and described in a study published May 20, 2015 in the open-access journal PLOS ONE by Brandon Peecook and Christian Sidor from the Burke Museum of Natural History and Culture at the University of Washington.
The fossils were discovered while collecting ammonite fossils (a nautilus-like creature) from a marine rock unit known as the Cedar District Formation. The authors of the study describe the fossil as the partial left ...
Burke Museum paleontologists have published a description of the first dinosaur fossil from Washington state. The fossil was collected by a Burke Museum research team along the shores of Sucia Island State Park in the San Juan Islands.
Burke Museum researchers discovered the fossil while collecting ammonite fossils (a creature with a spiral shell) from a marine rock unit known as the Cedar District Formation. The researchers first noticed a small section of exposed bone on the surface of the rocks, then returned with a team of paleontologists to help excavate the fossil ...
