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Chronic obstructive pulmonary disease
Original research
QRISK3 underestimates the risk of cardiovascular events in patients with COPD
  1. Joseph Emil Amegadzie1,
  2. Zhiwei Gao2,
  3. Jennifer K Quint3,
  4. Richard Russell4,5,
  5. John R Hurst6,
  6. Tae Yoon Lee1,
  7. Don D Sin7,
  8. Wenjia Chen8,
  9. Mona Bafadhel5,
  10. Mohsen Sadatsafavi1
  1. 1Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
  3. 3School of Public Health, National Heart and Lung Institute, Imperial College London, London, UK
  4. 4Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  5. 5King's Centre of Lung Health, Peter Gorer Dept of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, London, UK
  6. 6Academic Unit of Respiratory Medicine, University College London Medical School, London, UK
  7. 7Centre for Heart Lung Innovation, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  8. 8Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  1. Correspondence to Dr Mohsen Sadatsafavi, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; msafavi{at}mail.ubc.ca

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied.

Methods We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998–July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool.

Results 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54–1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted).

Conclusion People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.

  • Clinical Epidemiology
  • COPD epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. This study is partly based on data from the Clinical Practice Research Datalink (CPRD-GOLD) obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone. Data are available upon request from the data custodian, the CPRD.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/thorax-2023-220615

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This study is partly based on data from the Clinical Practice Research Datalink (CPRD-GOLD) obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone. Data are available upon request from the data custodian, the CPRD.

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    Footnotes

    • Twitter @mo_safavi

    • Contributors MS and MB conceived the study question. JEA, MS and TYL developed the analytic plan, performed the literature review and conducted the analyses. ZG facilitated data access. MB and JKQ revised the initial study protocol. RR, JRH and DDS revised and finalised the protocol. MS, JKQ, TL, WC and MB supervised the study progress and provided regular feedback. JEA and MS contributed to the study design and TL performed part of the statistical analyses. JA wrote the first draft of the manuscript. All authors critically revised the manuscript and approved the final copy. MS is the guarantor of this work.

    • Funding This study was funded by The Canadian Institutes of Health Research (Team Grant PHT 178432). JEA was supported by Legacy for Airway Health and a scholarship from MITACS Canada.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.