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Chronic obstructive pulmonary disease and the risk of stroke: a systematic review

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Title: Chronic obstructive pulmonary disease and the risk of stroke: a systematic review
Authors: Morgan, A
Sharma, C
Rothnie, KJ
Potts, J
Smeeth, L
Quint, JK
Item Type: Journal Article
Abstract: Rationale Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for cardiovascular diseases such as myocardial infarction. The role of COPD in cerebrovascular disease is, however, less certain: although earlier studies have suggested that the risk for stroke is also increased in COPD, more recent investigations have generated mixed results. Objectives The primary objective of our review was to quantify the magnitude of the association between COPD and stroke. We also sought to clarify the nature of the relationship between COPD and stroke by investigating whether the risk of stroke in COPD varies with age, sex, smoking history and/or type of stroke and whether stroke risk is modified in particular COPD phenotypes. Methods A search of MEDLINE and EMBASE databases was conducted in May 2016 to identify articles which compared stroke outcomes in people with and without COPD. Studies were grouped by study design to distinguish those which reported prevalence of stroke (cross-sectional studies) from those which estimated incidence (cohort or case–control studies). Additionally, studies were stratified according to study population characteristics, the nature of COPD case definitions, and adjustment for confounding (smoking). Heterogeneity was assessed using the I2 statistic. Results We identified 5,484 studies, of which 30 met our pre-defined inclusion criteria. Of the 25 studies which reported prevalence ratios, 11 also estimated prevalence odds ratios (PORs). The level of heterogeneity among these cross-sectional studies did not permit the calculation of pooled ratios, save for a group of four studies which estimated prevalence odds ratios adjusted for smoking (POR=1.51; 95%CI: 1.09–2.09; I2=45%). All 11 studies which estimated relative risk for non-fatal incident stroke reported increased risk in COPD. Adjustment for smoking invariably reduced the magnitude of the associations. Conclusion Although both prevalence and incidence of stroke is increased in people with COPD, the weight of evidence does not support the hypothesis that COPD is an independent risk factor for stroke. The possibility remains that COPD is causal in certain subsets of COPD patients and for certain stroke subtypes.
Issue Date: 1-May-2017
Date of Acceptance: 15-Feb-2017
URI: http://hdl.handle.net/10044/1/44916
DOI: https://dx.doi.org/10.1513/AnnalsATS.201611-932SR
ISSN: 2329-6933
Publisher: American Thoracic Society
Start Page: 754
End Page: 765
Journal / Book Title: Annals of the American Thoracic Society
Volume: 14
Issue: 5
Copyright Statement: Copyright © 2017 by the American Thoracic Society. Final publication is available from Mary Ann Liebert, Inc., publishers http://www.atsjournals.org/doi/10.1513/AnnalsATS.201611-932SR#readcube-epdf
Sponsor/Funder: British Lung Foundation
Funder's Grant Number: RG14-5
Publication Status: Published
Appears in Collections:Infectious Disease Epidemiology
National Heart and Lung Institute
Faculty of Medicine



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