COPD and cardiovascular diseases (CVDs) are two of the leading causes of morbidity and mortality in the United States. The estimated total annual cost to the United States for CVDs is $368.1 billion, and for COPD $32.1 billion. The incidence of and mortality from these diseases increase with age, A number of studies have shown an association between COPD and selected CVD end points including total cardiac mortality, mortality from acute myocardial infarction (AMI), mortality after coronary artery bypass graft, and pulmonary embolism. Low FEV1 is associated with all-cause mortality, CVD mortality, nonfatal and fatal myocardial infarction (MI), nonfatal and fatal stroke, and atrial fibrillation. There are several reasons for a COPD-CVD association, including a major shared risk factor (smoking) and a number of factors that may lead to increased stress on the cardiovascular system or to cardiac arrhythmias (eg, use of ^-agonist medications that may stimulate the cardiovascular system, hypoxemia, hyperventilation leading to respiratory alkalosis, and inflammation).
There is little in the published literature on the risk of CVD in persons with COPD, and we are unaware of studies that have prospectively examined the relationship of clinically diagnosed COPD with the incidence and mortality from CVD relative to an appropriately matched comparison group of individuals without COPD. In order to increase knowledge of the association between COPD and CVD, we examined the relationship of clinically diagnosed COPD to the incidence of several CVD end points in the Kaiser Permanente Medical Care Program of Northern California (KPNC), a large integrated health-care system.