Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis.
BACKGROUND
Comorbidities can affect disease progression and/or response to treatment in various conditions. Comorbid conditions are prevalent in patients with pulmonary arterial hypertension (PAH); however, their effect on patient outcomes remains unknown.


METHODS
We evaluated the effect on functional class (FC), 6-min walk test distance (6MWD), and survival of the seven most common, comorbid conditions at enrollment in patients with PAH from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry): hypertension, clinical depression, type 2 diabetes mellitus (diabetes), obesity, COPD, sleep apnea, and thyroid disease.


RESULTS
Patients with COPD or diabetes had the shortest 6MWD at enrollment (304.5 and 304.6 m, respectively) vs other comorbidities. Adjusted linear regression for 6MWD at enrollment revealed significant reductions among patients who were hypertensive, obese, diabetic, or had COPD (P<.001). A larger proportion of patients who were obese or had COPD were FC III/IV vs FC I/II at enrollment (P<.001). There was a greater risk for death among patients with diabetes (hazard ratio [HR], 1.73; 95% CI, 1.40-2.13; P<.001) or COPD (HR, 1.59; 95% CI, 1.34-1.90; P<.001), but there was a reduced risk for death in patients who were obese (HR, 0.73; 95% CI, 0.61-0.86; P<.001).


CONCLUSIONS
Compared with other analyzed comorbidities in patients with PAH, hypertension, obesity, diabetes, and COPD were associated with significantly worse 6MWD; obesity and COPD were associated with worse FC; and diabetes and COPD were associated with increased risk for death. Further investigation of the effects of treating these comorbidities in patients with PAH is warranted.


BACKGROUND
ClinicalTrials.gov; Identifier: NCT00370214; URL: www.clinicaltrials.gov.
Duke University School of Medicine, Durham, NC. Electronic address: abby.poms@duke.edu.
Abby D
AD
Poms
ICON Late Phase & Outcomes Research, San Francisco, CA.
Michelle
M
Turner
Boston University School of Medicine, Boston, MA.
Harrison W
HW
Farber
Actelion Pharmaceuticals US, Inc, South San Francisco, CA.
Leslie A
LA
Meltzer
Mayo Clinic, Rochester, MN.
Michael D
MD
McGoon
D000328:Adult; D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D019468:Disease Management; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012042:Registries; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D015996:Survival Rate; D013959:Thyroid Diseases / Q000453:epidemiology; D016896:Treatment Outcome