title: CHA2DS2-VASc scores predict major adverse cardiovascular events in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) frequently experience concurrent comorbidities; therefore, risk assessment for major adverse cardiovascular events (MACEs) is very important.
  
  
  OBJECTIVE
  We explored the association between COPD and risk of MACEs with three common clinical events: acute myocardial infarction (AMI), ischemic stroke (IS), and cardiovascular death (CVD).
  
  
  METHODS
  We evaluated the predictive value of the CHA2DS2-VASc score (congestive heart failure [C], hypertension [H], age [A], diabetes [D], stroke [S], and vascular disease [VASc]) for MACEs in COPD patients. In this observational study, we retrospectively reviewed the records of 29 258 patients with COPD between 2005 and 2009 in relation to MACE risk using the CHA2DS2-VASc score. We calculated the hazard ratios (HR) and 95% confidence intervals (CI) using a significance level of .05.
  
  
  RESULTS
  Patients with COPD had significantly (P < .001) increased risk of MACEs, and a high prevalence of CHA2DS2-VASc scores ≥ 6, predicting MACEs (16.1%), AMI (3.3%), IS (8.7%), and CVD (4.0%). A good discrimination was found for MACEs, IS events, and CVD events (AUC = 0.740, 0.739, and 0.778, respectively) but poorer discrimination for AMI events (AUC = 0.697).
  
  
  CONCLUSIONS
  Early lifestyle modifications and antithrombotic therapy may be essential for COPD patients at a high risk of MACEs, that is, those with CHA2DS2-VASc scores ≥ 6.
authors.affiliation: Department of Preventive Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.|Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.|Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, No. 11, Buzih Lane 40601, Taiwan.|Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan. No. 2, Yu der Road, Taichung City 40447, Taiwan.
authors.forename: Hean
authors.initials: H
authors.lastname: Ooi
authors.affiliation: Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.
authors.forename: Li-Hsiou
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.
authors.forename: Yung-Lun
authors.initials: YL
authors.lastname: Ni
authors.affiliation: Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.
authors.forename: Huan-Ting
authors.initials: HT
authors.lastname: Shen
authors.affiliation: Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.
authors.forename: Yen-Hsien
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chu
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Ke-Chih
authors.initials: KC
authors.lastname: Fang
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: I-Hung
authors.initials: IH
authors.lastname: Chen
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Shu-Lan
authors.initials: SL
authors.lastname: Hsu
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Hsing-Chun
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Chien-Hsiu
authors.initials: CH
authors.lastname: Huang
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Fan
authors.affiliation: Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan.|Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan.|Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: Liang-Wen
authors.initials: LW
authors.lastname: Hang
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: COPD; MACE; ischemia; myocardial infarction