Cardiovascular risk scores should include COPD as a factor to address the lack of awareness of the link between the two conditions, the Pulse LIVE conference has heard.
Presenting data on preventing exacerbations in COPD patients, respiratory researcher from the University of Oxford Dr Richard Russell said cardiovascular disease (CVD) was common in patients with COPD but was under-recognised and prevention needed to be taken more seriously.
Within five days of a COPD exacerbation, the risk of a heart attack is doubled, and within 10 days the risk of stroke has increased 40%, he told delegates at Pulse’s flagship conference in London.
‘There have been estimates that around 40% of people in heart failure clinics have got COPD and vice versa,’ he said.
Dr Russell noted that many co-morbidities were already included in QRISK scores including lupus, chronic kidney disease and severe mental illness yet COPD – which is known to be associated with 2.5 times greater risk of having cardiovascular disease – was not.
And COPD patients with co-existing cardiovascular disease are at increased risk of poor outcomes including death and hospitalisation, he added.
‘I think it would be entirely reasonable and entirely justifiable to challenge why COPD is not included,’ he said.
Issues that have prevented more focus on managing these commonly co-existing comorbidities include a lack of evidence-based guidance and myths around potential drug contraindications, he added.
He said: ‘We need to have a more preventive mindset in general when it comes to COPD and think “do we appreciate risk and the value of intervention?”
‘There still is a significant amount of therapeutic nihilism, not just in primary care but secondary care too, that nothing can be done.
‘Looking at the impact of COPD and cardiovascular disease, there is significant impact there. And the challenge to us is – do we consider that and do we properly mitigate that? I would argue that we don’t.’
More recently, data from the ETHOS trial has shown that proactive early prevention of COPD exacerbations also had a protective effect on cardiovascular mortality.
Dr Russell said while GPs would likely already do blood pressure and cholesterol checks in patients, an annual ECG would also be worthwhile in those with COPD.
Speaking to Pulse after the event, he also pointed to a paper by colleague Professor Jennifer Quint, professor of respiratory epidemiology at Imperial College London, which advocated more active assessment for signs of cardiovascular conditions in all COPD patients but particularly those aged under 65 years who would benefit the most.
‘There’s a lot we could do that would impact both respiratory and cardiovascular morbidity and mortality,’ he said.
Former health secretary Jeremy Hunt and RCGP chair Professor Martin Marshall delivered keynote addresses at the Pulse conference last month, which also featured an interview with RCGP president Professor Dame Clare Gerada.