COPD strokes...

Chronic Obstructive Pulmonary Disease and the Risk of Stroke.

Morgan AD1, Sharma C2, Rothnie KJ1,3, Potts J1, Smeeth L3, Quint JK1,3.

Author information

Abstract

RATIONALE:

Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for cardiovascular diseases such as myocardial infarction. The role of COPD in cerebrovascular disease is, however, less certain. Although earlier studies have suggested that the risk for stroke is also increased in COPD, more recent investigations have generated mixed results.

OBJECTIVES:

The primary objective of our review was to quantify the magnitude of the association between COPD and stroke. We also sought to clarify the nature of the relationship between COPD and stroke by investigating whether the risk of stroke in COPD varies with age, sex, smoking history, and/or type of stroke and whether stroke risk is modified in particular COPD phenotypes.

RESULTS:

The MEDLINE and EMBASE databases were searched in May 2016 to identify articles that compared stroke outcomes in people with and without COPD. Studies were grouped by study design to distinguish those that reported prevalence of stroke (cross-sectional studies) from those that estimated incidence (cohort or case-control studies). In addition, studies were stratified according to study population characteristics, the nature of COPD case definitions, and adjustment for confounding (smoking). Heterogeneity was assessed using the I2statistic. We identified 5,493 studies, of which 30 met our predefined inclusion criteria. Of the 25 studies that reported prevalence ratios, 11 also estimated prevalence odds ratios. The level of heterogeneity among the included cross-sectional studies did not permit the calculation of pooled ratios, save for a group of four studies that estimated prevalence odds ratios adjusted for smoking (prevalence odds ratio, 1.51; 95% confidence interval, 1.09-2.09; I2 = 45%). All 11 studies that estimated relative risk for nonfatal incident stroke reported increased risk in COPD. Adjustment for smoking invariably reduced the magnitude of the associations.

CONCLUSIONS:

Although both prevalence and incidence of stroke are increased in people with COPD, the weight of evidence does not support the hypothesis that COPD is an independent risk factor for stroke. The possibility remains that COPD is causal in certain subsets of patients with COPD and for certain stroke subtypes.

Read more

COPD and strokes

Rationale: Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD.

Objectives: To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations.

Methods: Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model.

Measurements and Main Results: COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00–1.43), ischemic stroke (HR, 1.27; 1.02–1.59), and hemorrhagic stroke (HR, 1.70; 1.01–2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91–1.31) for all stroke; HR, 1.13 (0.91–1.42) for ischemic stroke; and HR 1.53 (0.91–2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42–18.20) increased risk of stroke.

Conclusions: Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.

Read more

COPD - strokes....

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.

Many people mistake their increased breathlessness and coughing as a normal part of aging. In the early stages of the disease, you may not notice the symptoms. COPD can develop for years without noticeable shortness of breath. You begin to see the symptoms in the more developed stages of the disease. That’s why it is important that you talk to your doctor as soon as you notice any of these symptoms. Ask your doctor about taking a spirometry test.

What are the signs and symptoms of COPD?

• Increased breathlessness
• Frequent coughing (with and without sputum)
• Wheezing
• Tightness in the chest

How common is COPD?

COPD affects an estimated 30 million individuals in the U.S., and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.

What are the risk factors and common causes of COPD?

Most cases of COPD are caused by inhaling pollutants; that includes smoking (cigarettes, pipes, cigars, etc.), and second-hand smoke.

Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD.

Genetics can also play a role in an individual’s development of COPD—even if the person has never smoked or has ever been exposed to strong lung irritants in the workplace.

Here is more information on the top three risk factors for developing COPD:

Smoking

COPD most often occurs in people 40 years of age and older who have a history of smoking. These may be individuals who are current or former smokers. While not everybody who smokes gets COPD, most of the individuals who have COPD (about 90% of them) have smoked.

Environmental Factors

COPD can also occur in those who have had long-term contact with harmful pollutants in the workplace. Some of these harmful lung irritants include certain chemicals, dust, or fumes. Heavy or long-term contact with secondhand smoke or other lung irritants in the home, such as organic cooking fuel, may also cause COPD.

Genetic Factors

Even if an individual has never smoked or been exposed to pollutants for an extended period of time, they can still develop COPD. Alpha-1 Antitrypsin Deficiency (AATD) is the most commonly known genetic risk factor for emphysema2. Alpha-1 Antitrypsin related COPD is caused by a deficiency of the Alpha-1 Antitrypsin protein in the bloodstream. Without the Alpha-1 Antitrypsin protein, white blood cells begin to harm the lungs and lung deterioration occurs. The World Health Organization and the American Thoracic Society recommends that every individual diagnosed with COPD be tested for Alpha-1. For more information about AATD and how to get tested, visit the ALPHA-1 FOUNDATION WEBSITE or call 1-877-2 CURE-A1.

Because not all individuals with COPD have AATD, and because some individuals with COPD have never smoked, it is believed that there are other genetic predispositions to developing COPD. Read about the COPDGENE™ STUDY to learn about research to find other genetic causes of Chronic Obstructive Pulmonary Disease.

Read more