{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:27:34Z","timestamp":1790508454695,"version":"4.1.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>People living with chronic obstructive pulmonary disease (COPD) have an increased risk of experiencing cardiovascular (CV) events, particularly after an exacerbation. Such CV burden is not yet known for incident COPD patients. We examined the risk of severe CV events in incident COPD patients in periods following either moderate and\/or severe exacerbations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Persons aged\u2009\u2265\u200940\u00a0years with an incident COPD diagnosis from the PHARMO Data Network were included. Exposed time periods included 1\u20137, 8\u201314, 15\u201330, 31\u2013180 and 181\u2013365\u00a0days following an exacerbation. Moderate exacerbations were defined as those managed in outpatient settings; severe exacerbations as those requiring hospitalisation. The outcome was a composite of time to first severe CV event (acute coronary syndrome, heart failure decompensation, cerebral ischaemia, or arrhythmia) or death. Hazard ratios (HR) were estimated for association between each exposed period and outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>8020 patients with newly diagnosed COPD were identified. 2234 patients (28%) had\u2009\u2265\u20091 exacerbation, 631 patients (8%) had a non-fatal CV event, and 461 patients (5%) died during a median follow-up of 36\u00a0months. The risk of experiencing the composite outcome was increased following a moderate\/severe exacerbation as compared to time periods of stable disease [range of HR: from 15.3 (95% confidence interval 11.8\u201320.0) in days 1\u20137 to 1.3 (1.0\u20131.8) in days 181\u2013365]. After a moderate exacerbation, the risk was increased over the first 180\u00a0days [HR 2.5 (1.3\u20134.8) in days 1\u20137 to 1.6 (1.3\u20132.1) in days 31\u2013180]. After a severe exacerbation, the risk increased substantially and remained higher over the year following the exacerbation [HR 48.6 (36.9\u201364.0) in days 1\u20137 down to 1.6 (1.0\u20132.6) in days 181\u2013365]. Increase in risk concerned all categories of severe CV events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Among incident COPD patients, we observed a substantial risk increase of severe CV events or all-cause death following either a moderate or severe exacerbation of COPD. Increase in risk was highest in the initial period following an exacerbation. These findings highlight the significant cardiopulmonary burden among people living with COPD even with a new diagnosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12931-023-02601-4","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T12:02:01Z","timestamp":1700568121000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Risk of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: results from the EXACOS-CV cohort study using the PHARMO Data Network in the Netherlands"],"prefix":"10.1186","volume":"24","author":[{"given":"Karin M. 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Frequency and severity of exacerbations of COPD associated with future risk of exacerbations and mortality: a UK routine health care data study. Int J Chron Obstruct Pulmon Dis. 2022;17:427\u201337.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"4","key":"2601_CR3","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1378\/chest.12-2847","volume":"144","author":"H Mullerova","year":"2013","unstructured":"Mullerova H, Agusti A, Erqou S, Mapel DW. Cardiovascular comorbidity in COPD: systematic literature review. Chest. 2013;144(4):1163\u201378.","journal-title":"Chest"},{"key":"2601_CR4","doi-asserted-by":"publisher","first-page":"175346662211136","DOI":"10.1177\/17534666221113647","volume":"16","author":"H Mullerova","year":"2022","unstructured":"Mullerova H, Marshall J, de Nigris E, Varghese P, Pooley N, Embleton N, et al. Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis. 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The study was conducted in accordance with the ethical principles outlined in the declaration of Helsinki. All data sources used were linked through probabilistic linkage using demographic variables of the patients by STIZON (ISO27001\/NEN7510 certified TTP). All identifying information was deleted after linkage of the various databases. This approach is approved by the Dutch Data Protection Authority ('College Bescherming Persoonsgegevens'). STIZON acts as processor for the care givers (who remain controller of the data) and STIZON has a General Data Protection Regulations (GDPR) proof processing agreement in place with all care givers. Caregivers have to inform their patients, who can opt out at any time. The PHARMO Institute only works with anonymised data without access to personal identifying information.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KS, BB, LL, FPB and RH are employees of the PHARMO Institute for Drug Outcomes Research. This independent research institute performs financially supported studies for government and related healthcare authorities and several pharmaceutical companies. ML, FH, DV, and CB are employees of IQVIA, a contract research organization that performs financially supported studies for pharmaceutical companies. EG has been a consultant to AstraZeneca on this project and has previously chaired a department at the Leibniz Institute that occasionally conducted studies for pharmaceutical companies, including Bayer, Nycomed, Celgene, Glaxo-Smith-Kline, Mundipharma, Novartis, Sanofi-Aventis, Sanofi Pasteur MSD and STADA. CN, LB and KR are employees of AstraZeneca and own shares in AstraZeneca. SS has received grants or contracts from AstraZeneca, GlaxoSmithKline, Roche and Boehringer Ingelheim, outside the submitted work; consulting fees from Chiesi and GlaxoSmithKline, outside the submitted work; honoraria received from AstraZeneca and Chiesi for lectures outside the submitted work; support for attending meetings from Chiesi, outside the submitted work; honoraria for advisory board for AstraZeneca, Chiesi and Boehringer Ingelheim, outside the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"293"}}