Cardiovascular–kidney–metabolic (CKM) disease and chronic obstructive pulmonary disease (COPD) frequently coexist and may contribute to elevated cardiovascular risk. This population-based cohort study published in BMC Medicine evaluated associations between COPD and major adverse cardiovascular events (MACE). 

Linked data from Clinical Practice Research Datalink, Hospital Episode Statistics, and the Office for National Statistics were analyzed between January 2010 and March 2021. Five cohorts were created: chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), obesity, prior MACE, and adults aged ≥65 years. CKD, T2DM, obesity, and Age65+ cohorts were MACE-naïve at baseline. Exposures included COPD, incident COPD, and individuals at risk of COPD without diagnosis (≥40 years, smoking history, no asthma, frequent respiratory infections). Cox proportional hazards models evaluated associations with subsequent MACE.

Across cohorts, COPD was associated with higher MACE risk across cohorts: CKD (adjusted hazard ratio [aHR] 1.29; 95% CI 1.26–1.32), T2DM (1.30; 1.26–1.35), obesity (1.41; 1.34–1.48), prior MACE (1.04; 1.02–1.06), and Age65+ (1.59; 1.52–1.66). Incident COPD was associated with MACE in CKD only (aHR 1.28; 1.13–1.45). Inhaled corticosteroids (ICS) prescription was not associated with reduced MACE risk.

COPD was independently associated with higher MACE risk across CKM populations. ICS use was not associated with modification of MACE risk in CKM–COPD groups.