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Title: Vascular disease in people with COPD : working towards better prevention and treatment
Author: Morgan, Ann
ISNI:       0000 0004 9350 7934
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2019
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Cardiovascular diseases (CVDs) are not only common among people with chronic obstructive pulmonary disease (COPD), but are also an important cause of death. It is hypothesised that improved diagnosis and management of concomitant CVD has the potential to decrease morbidity and mortality in this patient population. The aims of this research project were: i. to estimate absolute and relative risks for a range of individual CVD outcomes in the UK COPD population, by age group and gender; ii. to investigate whether people with COPD receive the same level of secondary prevention for stroke as people without COPD and whether they are at a disadvantage in terms of post-stroke mortality; and iii. to identify risk factors for ischaemic stroke in the period immediately following a severe acute exacerbation of COPD (AECOPD). Individual analyses revealed that CVD disease risks in COPD are not confined to acute events (myocardial infarction, stroke) but exist across a wide range of CVD outcomes. While people with COPD were just as likely to receive secondary prevention medications for stroke, they were more likely to die following a stroke than people without COPD. Finally, people who had a prior history of CVD, in particular myocardial infarction, stroke and heart failure, were at greater risk for stroke post-AECOPD but being on an ICS-containing therapy may offer a degree of protection. Collectively, results provided evidence in favour of targeting CVD comorbidities as a strategy to improve outcomes for people with COPD. Key time points for interventions include a) on COPD diagnosis and/or annual review (i.e. in mid-to-late middle age at which time primary prevention may be considered to manage CVD risks) and b) on admission for AECOPD (at which time additional investigations for underlying cardiac conditions could be initiated, if indicated).
Supervisor: Quint, Jennifer Sponsor: British Lung Foundation
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral