Uncontrolled diabetes elevates COPD exacerbation risk

Patients with chronic obstructive pulmonary disease (COPD) had a significantly higher risk for cardiovascular events in the 30 days following a moderate-to-severe exacerbation in a post hoc analysis of data from the single-inhaler triple COPD therapy IMPACT study.

The risk of having a cardiovascular event was highest during a severe COPD exacerbation (hazard ratio, 21.84, P<0.001), but the risk decreased over time (HR, 1.12; P=0.720 at 3 months to a year following severe exacerbation), the researchers found.

The post hoc analysis of the IMPACT trial was one of several studies exploring comorbidities and outcomes among patients with COPD presented in poster sessions this week at the virtual meeting of the American College of Chest Physicians — CHEST 2020.

Uncontrolled diabetes was found to be a risk factor for hospitalization due to acute COPD exacerbation in a retrospective analysis involving patients hospitalized in Florida.

The IMPACT trial was a phase III randomized, double-blind, 52-week trial comparing once-daily fluticasone furoate/ umeclidinium/vilanterol (FF/UMEC/VI) against FF/VI and UMEC/VI in patients with symptomatic COPD and a history of exacerbations in the prior year.

In the post hoc analysis, cardiovascular adverse events of special interest (CVAESI) included cardiac arrhythmia, cardiac failure, central nervous system hemorrhages and cerebrovascular conditions, hypertension, and ischemic heart disease.

IMPACT researcher Mark Dransfield, MD, of the University of Alabama School of Medicine, Birmingham, and colleagues examined the risk (time to first [TTF]) of CVAESI or CVAESI resulting in hospitalization or death during an exacerbation and 1–30 days, 31–90 days, and 91–365 days following an exacerbation, using a time-dependent repeated measures Cox model.

The hazard for a cardiovascular event was compared between the period before and after an exacerbation, and they were repeated by prior exacerbation history (≥2 moderate or ≥1 severe, <2 moderate and 0 severe) and CV risk factors at baseline (0, 1, ≥2).

Among the main findings:

  • Risk of a CVAESI increased significantly during a moderate (HR, 2.63, P<0.001) or severe (HR 21.84, P<0.001) exacerbation event.
  • Risk decreased over time after moderate exacerbation (1–30 days: HR 1.63, P<0.001; 31–90 days HR, 0.90, P=0.486; 91–365 days, HR 0.95, P=0.720) and severe exacerbation (1–30 days, HR, 1.75, P=0.055; 31–90 days, HR, 1.61, P=0.091; 91–365 days, HR, 1.12, P=0.725).
  • Risk of CVAESI resulting in hospitalization or death was also significantly elevated during an exacerbation event (moderate, HR 2.46; severe, HR 41.29; both P<0.001).
  • This risk also decreased over time post moderate exacerbation (1–30 days: HR 2.00, P=0.001; 31–90 days: HR 1.36, P=0.186; 91–365 days: HR 0.90, P=0.696) and severe exacerbation (1–30 days: HR 4.39, P<0.001; 31–90 days: HR 0.81, P=0.764; 91–365 days: HR 2.06, P=0.087).

The researchers concluded that their post hoc analysis “confirms the increased risk of CVAESI during and in the first 30 days following an exacerbation seen in other studies, highlighting a need for exacerbation prevention and close patient monitoring following exacerbation events.”

The retrospective preliminary trial exploring the impact of uncontrolled diabetes on COPD exacerbation frequency included 1,516 patients with COPD hospitalized at hospitals from a single health system in Eastern Florida classified into groups of incremental hbA1c levels (5.1-6.0 to levels of 9.1-10).

Researcher Vijay Srinivasan and colleagues assessed rates of acute exacerbations for each hbA1c level evaluated. A chi-square model was used to identify the association and incidence of diabetes mellitus and its effect on the frequency of acute COPD exacerbation.

Roughly 17% of patients with an HbA1c of 5.1-6.0 had COPD exacerbations, compared to roughly 19% of patients with HbA1c levels in the range of 6.1-7.0, and 21.53% in the hbA1c range of 7.1 – 8.0.

“Although there was a 1.18% decline in the frequency of patients with COPD exacerbations from HbA1c levels 8.1-9.0, there was a significant 5.31% surge in the frequency of COPD exacerbations in patients with levels of HbA1c of 9.1-10.0,” the researchers wrote, adding that the results “strongly implicate uncontrolled blood sugars as an influencing factor in the frequency of acute exacerbations of COPD.”

  1. Patients with chronic obstructive pulmonary disease had a significantly higher risk for cardiovascular events in the 30 days following a moderate-to-severe exacerbation in a post hoc analysis of data from the single-inhaler triple COPD therapy IMPACT study.

  2. Uncontrolled diabetes was found to be a risk factor for hospitalization due to acute COPD exacerbation in a retrospective analysis of patients hospitalized in Florida.

Salynn Boyles, Contributing Writer, BreakingMED™

The IMPACT study was funded by GlaxoSmithKline.

Lead researcher Mark Dransfield reported receiving consulting fees from GlaxoSmithKline, AstraZeneca, PneumRx/BTG, Quark, and Pulmonx. Other researchers also reported financial relationships with GlaxoSmithKline and other pharmeutical companies.

No funding source was reported for the COPD and diabetes trial. The researchers reported no relevant relationships with industry related to the study.

Cat ID: 154

Topic ID: 89,154,143,192,154,195,925,224