Chronic obstructive pulmonary disease and sudden cardiac death: the Rotterdam study.
OBJECTIVE
Both sudden cardiac death (SCD) and chronic obstructive pulmonary disease (COPD) are common conditions in the elderly. Previous studies have identified an association between COPD and cardiovascular disease, and with SCD in specific patient groups. Our aim was to investigate whether there is an association between COPD and SCD in the general population.


RESULTS
The Rotterdam study is a population-based cohort study among 14 926 subjects aged 45 years and older with up to 24 years of follow-up. Analyses were performed with a (time dependent) Cox proportional hazard model adjusted for age, sex, and smoking. Of the 13 471 persons included in the analysis; 1615 had a diagnosis of COPD and there were 551 cases of SCD. Chronic obstructive pulmonary disease was associated with an increased risk of SCD (age- and sex-adjusted hazard ratio, HR, 1.34, 95% CI 1.06-1.70). The risk particularly increased in the period 2000 days (5.48 years) after the diagnosis of COPD (age- and sex-adjusted HR 2.12, 95% CI 1.60-2.82) and increased further to a more than three-fold higher risk in COPD subjects with frequent exacerbations during this period (age- and sex-adjusted HR 3.58, 95% CI 2.35-5.44). Analyses restricted to persons without prevalent myocardial infarction or heart failure yielded similar results.


CONCLUSIONS
Chronic obstructive pulmonary disease is associated with an increased risk for SCD. The risk especially increases in persons with frequent exacerbations 5 years after the diagnosis of COPD. This risk indicator could provide new directions for better-targeted actions to prevent SCD.
Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Lies
L
Lahousse
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Maartje N
MN
Niemeijer
Department of Medical Informatics, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Marten E
ME
van den Berg
Department of Medical Informatics, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Peter R
PR
Rijnbeek
Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Guy F
GF
Joos
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Albert
A
Hofman
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Oscar H
OH
Franco
Department of Cardiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Jaap W
JW
Deckers
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Mark
M
Eijgelsheim
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Inspectorate of Healthcare, The Hague, The Netherlands b.stricker@erasmusmc.nl.
Bruno H
BH
Stricker
Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Respiratory Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Guy G
GG
Brusselle
D000368:Aged; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors
Cardiovascular mortality; Comorbidity; General population; Sudden cardiac death