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Impact of chronic obstructive pulmonary disease on the outcomes of patients with peripheral artery disease

Smoking is one of the leading causes of PAD and COPD, both of which have high mortality rates.

In smokers with COPD, cardiovascular disease is one of the leading causes of death. Associations between COPD in smokers and coronary artery disease, myocardial infarction and pulmonary embolism are well established. Moreover, there is a growing body of evidence that COPD and smoking are associated with lower limb artery cardiovascular disease, which can contribute to PAD.

Data from a nationwide German patient sample was used in this retrospective cohort study to investigate the impact of COPD on in-hospital outcomes of PAD patients, especially death. PAD patients were classified into two groups based on COPD status and compared for comorbidities and in-hospital outcomes.

Between January 2005 and December 2015, a total of 5,611,827 patients aged ≥18 years were treated for PAD in hospitals in Germany. Of these, 761,011 had COPD and 4,850,816 did not, from which a total of 277,894 PAD patients died in hospital across both groups. Secondary outcomes during in-hospital stays, such as myocardial infarction, pulmonary embolism and deep vein thrombosis, were also recorded.

The study authors found in-hospital mortality to be significantly higher in PAD patients with concomitant COPD compared with those without COPD. It was also found that COPD in PAD patients was associated with a higher prevalence of myocardial infarction, pulmonary embolism, deep vein thrombosis and cancer. Interestingly, PAD patients with COPD typically showed lower PAD stages than those without COPD. A statistical analysis found COPD to be an independent predictor of in‑hospital death and pulmonary embolism in PAD patients, although PAD patients with COPD had a lower risk of amputation.

The authors conclude that there is an increased risk of in-hospital death in PAD patients with COPD, most likely driven by higher frequencies of pulmonary embolism and cancer. This has two major implications for treatment: (1) PAD patients with a history of smoking may benefit from COPD screening, (2) PAD patients diagnosed with comorbid COPD are at an increased risk of complications; therefore, they should be monitored more closely.

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