Kaifang Meng,1– 5,* Xinran Zhang,2– 6,* Huaping Dai1– 5 

1Capital Medical University, Beijing, People’s Republic of China; 2National Center for Respiratory Medicine, Beijing, People’s Republic of China; 3National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China; 4State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 6Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Huaping Dai, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Email daihuaping@ccmu.edu.cn

Background: Cardiovascular disease (CVD), as the most common comorbidity of chronic obstructive pulmonary disease (COPD), has received much attention. However, robust evidence of the relationship between other obstructive airway disease (OAD) phenotypes, such as asthma, asthma-COPD overlap (ACO), and CVD risk is limited. We aimed to compare the magnitude of CVD risk across different OAD phenotypes using two nationwide population-based studies.
Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey 1999– 2018 (N=44,972, representing 183,508,900 adults). Survey-weighted descriptive analysis and logistic regression were used to investigate the prevalence of CVD (including heart failure, coronary heart disease, angina pectoris, and myocardial infarction) across OAD phenotypes and calculate odds ratios (ORs) with 95% confidence intervals (CIs). Additionally, longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) (N=13,533) were analyzed to validate these findings and calculate hazard ratios (HRs) with 95% CIs for new-onset CVD using Cox proportional hazards models.
Results: The weighted prevalence of at least one CVD in asthma, COPD, and ACO was 6.21%, 16.82%, and 20.75%, respectively. Individuals with asthma, COPD, and ACO had a significantly higher prevalence of CVD than those without OAD, with ORs of 1.55 (95% CI: 1.34– 1.78), 1.76 (95% CI: 1.50– 2.07), and 2.99 (95% CI: 2.47– 3.61), respectively. During the 9-year follow-up, 2,444 (18.1%) individuals developed CVD in CHARLS. The incidence of CVD was significantly higher in individuals with asthma (HR=1.67, 95% CI: 1.26– 2.21), COPD (HR=1.71, 95% CI: 1.48– 1.97), and ACO (HR=2.67, 95% CI: 2.21– 3.24) than those without OAD.
Conclusion: Individuals with OAD have a higher prevalence of comorbid CVD and an increased risk of developing CVD independent of phenotype, especially in those with ACO. These findings emphasize the need for awareness and appropriate cardiovascular screening in OAD.

Keywords: obstructive airway disease, asthma, COPD, asthma-COPD overlap, cardiovascular disease