Unmasking Cardiovascular Risk in Patients with COPD at Primary Care Settings: The Critical Role of Age, Sex, and Smoking

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition frequently associated with cardiovascular comorbidities, including ischemic heart disease (IHD), heart failure (HF), and atrial fibrillation (AF). These conditions significantly impact patient outcomes, yet their prevalence and risk factors remain underexplored in primary care settings. This study investigates the role of age, sex, and smoking status in the prevalence of IHD, HF, and AF among patients with COPD managed in general practice settings. Methods: A retrospective analysis was conducted using de-identified electronic health records from eleven general practitioner (GP) practices in Northern Ireland. Patients with COPD were identified through the Quality and Outcomes Framework (QOF) register, and the presence of IHD, HF, and AF was recorded. Statistical analyses included chi-square tests and independent t-tests to examine associations between cardiovascular comorbidities and patient demographics, with significance set at p < 0.05. Results: Among the total registered population of 77,797, there were 1575 patients with COPD, of whom 335 had IHD, 211 had AF, and 116 had HF. Patients with COPD had a significantly higher prevalence of IHD, AF, and HF compared to those without COPD. Age was a strong determinant, with older age groups, particularly those over 75 years, showing a markedly higher prevalence of all three conditions. Sex analysis revealed that male patients with COPD were significantly more likely to have IHD, AF, and HF than females. However, the association between smoking status and the presence of HF, IHD, or AF was not significantly different between current/ex-smokers and non-smokers. Conclusions: The findings highlight the high burden of cardiovascular comorbidities among patients with COPD in primary care and emphasise the need for routine cardiovascular screening. Given the strong influence of age and sex, targeted risk assessment and management strategies should be prioritised for older and male patients with COPD. The lack of association between smoking and cardiovascular comorbidities suggests that additional risk factors should be considered in cardiovascular risk assessment. A more integrated approach to managing COPD and cardiovascular conditions within general practice settings is essential to improve patient outcomes. Future research should focus on evaluating interventions that enhance early detection and multidisciplinary management of cardiovascular comorbidities in patients with COPD.

Keywords: COPD; cardiovascular comorbidities; general practice; primary care; smoking status.