Joint Association of Questionnaire-Defined COPD and Widened Pulse Pressure with Incident Cardiovascular Disease in Older Chinese Adults: A 7-Year CHARLS Cohort Study.

PURPOSE: COPD and vascular aging frequently coexist in later life. Whether widened pulse pressure identifies older adults with COPD at particularly high cardiovascular risk is uncertain.

PATIENTS AND

METHODS

We analyzed CHARLS participants aged 60 years or older without baseline heart disease or stroke. Questionnaire-defined COPD and widened pulse pressure (≥60 mmHg) formed four phenotypes. The primary outcome was incident physician-reported heart disease or stroke; all-cause mortality was secondary, and heart disease and stroke were component outcomes. Weighted cause-specific Cox models used respondent weights and household-cluster robust standard errors. Because the joint phenotype was selected after an exploratory screen of candidate vascular indicators, this study should be interpreted as hypothesis-generating rather than confirmatory.

RESULTS

Among 4183 participants, 943 developed incident cardiovascular disease and 685 died. Relative to neither exposure, COPD alone (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.84-1.57) and widened pulse pressure alone (HR 0.93, 95% CI 0.70-1.25) were not associated with cardiovascular disease, whereas both exposures were (HR 1.86, 95% CI 1.26-2.76). The cardiovascular association was present for heart disease (HR 2.80, 95% CI 1.94-4.05) but not stroke (HR 0.84, 95% CI 0.43-1.65). The composite cardiovascular signal should therefore not be read as a uniform effect across cardiovascular systems. For all-cause mortality, the both-exposure group had 63 deaths among 209 participants and a fully adjusted HR of 2.05 (95% CI 1.54-2.73) versus neither exposure, but mortality was not clearly higher than in the COPD-only group (HR 1.37, 95% CI 0.96-1.95).

CONCLUSION

Coexisting questionnaire-defined COPD and widened pulse pressure was associated with a higher risk of incident cardiovascular disease, primarily reported heart disease, and with higher all-cause mortality than neither exposure, although mortality was not clearly higher than among participants with COPD alone. These findings are hypothesis-generating and warrant external validation using objective pulmonary and vascular measures.