Increased risk of sudden cardiac arrest in obstructive pulmonary disease: a case-control study

PLoS One. 2013 Jun 6;8(6):e65638. doi: 10.1371/journal.pone.0065638. Print 2013.

Abstract

Background: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use.

Methods: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs.

Results: A higher risk of SCA was observed in patients with OPD (n = 190 cases [15%], 622 controls [11%]) than in those without OPD (OR adjusted for cardiovascular risk-profile 1.4 [1.2-1.6]). In OPD patients with a high cardiovascular risk-profile (OR 3.5 [2.7-4.4]) a higher risk of SCA was observed than in those with a low cardiovascular risk-profile (OR 1.3 [0.9-1.9]) The observed SCA risk was highest among OPD patients who received short-acting β2-adrenoreceptor agonists (SABA) or anticholinergics (AC) at the time of SCA (SABA OR: 3.9 [1.7-8.8], AC OR: 2.7 [1.5-4.8] compared to those without OPD).

Conclusions: OPD is associated with an increased observed risk of SCA. The most increased risk was observed in patients with a high cardiovascular risk-profile, and in those who received SABA and, possibly, those who received AC at the time of SCA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Death, Sudden, Cardiac / epidemiology*
  • Electrocardiography
  • Female
  • Humans
  • Logistic Models
  • Lung Diseases, Obstructive / epidemiology*
  • Male
  • Middle Aged
  • Risk Factors

Grant support

H.L. Tan was supported by the Netherlands Organization for Scientific Research (NWO, grant ZonMW Vici 918.86.616), the Dutch Medicines Evaluation Board (MEB/CBG), the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement nr. 241679 - the ARITMO project, and BBMRI-NL, a research infrastructure financed by the Dutch government (NWO 184-021-007). This study was conducted with unrestricted institutional funding from Utrecht University and the Utrecht University Medical Center. H.L. Tan was supported by the Netherlands Organization for Scientific Research (NWO, grant ZonMW Vici 918.86.616), the Dutch Medicines Evaluation Board (MEB/CBG), and the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement nr. 241679 - the ARITMO project and BBMRINL, a research infrastructure financed by the Dutch government (NWO 184-021-007).A. Bardai was supported by the Netherlands Organization for Scientific Research (NWO, grant Mozaiek 017.003.084). Both grants are unrestricted. M.L. De Bruin was supported by the Dutch Medicines Evaluation Board (CBG-MEB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.