title: Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care.
abstract: BACKGROUND
  Comorbidities associated with systemic inflammation including cardiovascular disease (CVD), stroke and diabetes mellitus (DM) are common among individuals with chronic obstructive pulmonary disease (COPD). A study was undertaken to quantify the burden of comorbidity and to determine the risk of first acute arteriovascular events among individuals with COPD.
  
  
  METHODS
  The computerised primary care records of 1,204,100 members of the general population aged ≥ 35 years on 25 February 2005 were searched for recordings of each disease. Data were analysed using multivariate logistic regression. Cox regression was used to determine whether individuals with COPD were at increased risk of acute myocardial infarction (MI) and stroke.
  
  
  RESULTS
  Cross-sectional analyses showed that physician-diagnosed COPD was associated with increased risks of CVD (OR 4.98, 95% CI 4.85 to 5.81; p<0.001), stroke (OR 3.34, 95% CI 3.21 to 3.48; p<0.001) and DM (OR 2.04, 95% CI 1.97 to 2.12; p<0.001). In the follow-up analyses, after adjusting for confounding by sex and smoking status and stratifying for age, the greatest increase in the rate of acute arteriovascular events was found in the youngest age groups; the HR for acute MI was 10.34 (95% CI 3.28 to 32.60; p<0.001) and for stroke the HR was 3.44 (95% CI 0.85 to 13.84; p<0.001) compared with the oldest age group.
  
  
  CONCLUSIONS
  Individuals with COPD are substantially more likely to have pre-existing CVD, DM or a previous stroke and are at high risk of acute arteriovascular events. National COPD guidelines and models of care need to adapt to provide an integrated approach to addressing these comorbidities.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK. jofeary@doctors.org.uk
authors.forename: Johanna R
authors.initials: JR
authors.lastname: Feary
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
authors.forename: Jack E
authors.initials: JE
authors.lastname: Gibson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D004812:Epidemiologic Methods; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011320:Primary Health Care / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology