More than one-third of patients with chronic obstructive pulmonary disease (COPD) have metabolic syndrome (MetS), and those with this comorbidity are at higher risk for stroke, coronary artery disease, and mortality, according to study findings reported in Therapeutic Advances in Respiratory Disease.
Metabolic syndrome is a common comorbidity of COPD. Researchers in Thailand sought to assess the prevalence of MetS in those with COPD as well as associated factors and clinical consequences after 5 years in this patient population.
The investigators conducted a prospective, observational study from June 2015 to November 2020 of patients at least 40 years of age with stable COPD at Songklanagarind Hospital in Thailand. A total of 115 patients with COPD were included (mean age, 73 years; 90% male), of whom 43 patients (37.4%) were diagnosed with MetS. Participants’ COPD diagnosis was based on the Global Initiative for Chronic Obstructive Lung Disease 2015 guidelines; MetS was defined using the International Diabetes Federation’s global definition of MetS. The primary outcome was MetS prevalence in patients with COPD. Secondary outcomes were associated factors and clinical consequences of MetS after 5 years.
Compared with the participants who had COPD without MetS, those with COPD and MetS had a higher rate of obesity (29.8 ± 3.0 kg/m2 vs 21.5 ± 3.1 kg/m2, respectively; P <.001), chronic bronchitis-type COPD (87% vs 9.7%; P <.001), and C-reactive protein (CRP) levels greater than 0.6 mg/L (58.1% vs 12.5%; P <.001). Multivariate analysis showed that chronic bronchitis-type COPD and high CRP levels in COPD (>0.6 mg/L) were significant potential predictors of MetS development in patients with COPD.
Screening for MetS in patients with COPD may facilitate earlier, proper management and prevention of clinical consequences.
Stroke, coronary artery disease, and mortality occurred significantly more frequently in patients with COPD and MetS vs those without MetS (34.9% vs 6.9%; 53.5% vs 4.2%; and 20.9% vs 2.8%, respectively). In multivariate analysis, stroke, coronary artery disease, exacerbation, and mortality were significant clinical consequences of MetS in patients with COPD: stroke (relative risk [RR], 15.36; 95% CI, 2.13-110.67); coronary artery disease (RR, 45.43; 95% CI, 4.61-447.07); exacerbation (RR, 1.95; 95% CI, 1.40-2.70); and mortality (RR, 48.01; 95% CI, 1.12-2049.43).
Patients with COPD with MetS vs without MetS also had a significantly higher use rate of long-acting muscarinic antagonists (34.9% vs 20.8%, P =.041) and a significantly higher annual exacerbation rate (2.0 vs 1.0).
Limitations include the single-center design and confounding factors such as family history of cardiovascular disease and physical inactivity, which also affect the consequences of MetS. In addition, female patients were 8% of the study population.
“These findings could alert pulmonologists to the importance of MetS in COPD patients,” stated the researchers. “Screening for MetS in patients with COPD may facilitate earlier, proper management and prevention of clinical consequences.”