title: Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease is an independent predictor of mortality in patients with myocardial infarction (MI). However, the impact on mode of death and risk of atherosclerotic events is unknown.
  
  
  RESULTS
  We assessed the risk of death and major cardiovascular (CV) events associated with chronic obstructive pulmonary disease in 14 703 patients with acute MI enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) trial. Cox proportional hazards models were used to evaluate the relationship between chronic obstructive pulmonary disease and CV outcomes. A total of 1258 (8.6%) patients had chronic obstructive pulmonary disease. Over a median follow-up period of 24.7 months, all-cause mortality was 30% in patients with chronic obstructive pulmonary disease, compared with 19% in those without. The adjusted hazard ratio (HR) for mortality was 1.14 (95% confidence interval 1.02-1.28). This reflected increased incidence of both non-CV death [HR 1.86 (1.43-2.42)] and sudden death [HR 1.26 (1.03-1.53)]. The unadjusted risk of all pre-specified CV outcomes was increased. However, after multivariate adjustment, chronic obstructive pulmonary disease was not an independent predictor of atherosclerotic events [MI or stroke: HR 0.98 (0.77-1.23)]. Mortality was significantly lower in patients receiving beta-blockers, irrespective of airway disease.
  
  
  CONCLUSIONS
  In high-risk patients with acute MI, chronic obstructive pulmonary disease is associated with increased mortality and non-fatal clinical events (both CV and non-CV). However, patients with chronic obstructive pulmonary disease did not experience a higher rate of atherosclerotic events.
authors.affiliation: Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. nathawkins@hotmail.com
authors.forename: Nathaniel M
authors.initials: NM
authors.lastname: Hawkins
authors.forename: Zhen
authors.initials: Z
authors.lastname: Huang
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D050197:Atherosclerosis; D002423:Cause of Death / Q000639:trends; D016001:Confidence Intervals; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine