Publication date: Nov 01, 2025
Comorbid cardiovascular disease has been reported extensively in community COPD populations, but to a lesser degree in acute hospital settings. Shared risk factors and acute infection both increase acute coronary syndrome (ACS) risk. Our objective is to assess a cohort of adults hospitalised for an acute lower respiratory tract infection (aLRTI) to determine whether COPD status is an independent risk factor for ACS. A prospective observational cohort study of adults aged ≥40 years (n=8496) with community-acquired aLRTI (Bristol, UK) was conducted between 27 July 2020 and 28 November 2022. Cases included physician diagnosis of COPD; controls were aLRTI without COPD. Outcomes included physician-diagnosed ACS occurring within 30 days of admission. Logistic regression models were adjusted for shared cardiovascular risk factors and aLRTI severity. 30-day ACS events in patients hospitalised with aLRTI with COPD were 7. 59% (190 out of 2502), versus without COPD 6. 96% (417 out of 5994) (p=0. 3094). Across both groups ACS incidence was 95. 1 events per 100 inpatient years. There was no association between COPD and 30-day ACS risk, when adjusting for shared cardiovascular risk factors (OR 1. 14, 95% CI 0. 93-1. 39). However, a diagnosis of COPD increased ACS risk in those without pneumonia versus controls (OR 1. 38, 95% CI 1. 02-1. 87). Markers of infection were associated with increased risk of ACS in both groups (white cell count >10cD710 cells.L OR 1. 31, 95% CI 1. 10-1. 56). Pneumonia was associated with the highest risk of ACS (OR 1. 49, 95% CI 1. 19-1. 87 (no COPD); OR 1. 46, 95% CI 1. 11-1. 92 (with COPD)). In this large, real-world cohort of hospitalised adults with aLRTI, 30-day ACS event rates were high at ∼7-13%. A diagnosis of COPD even in the absence of pneumonia increases ACS risk versus our control group without COPD. Markers of infection severity appear to be key drivers of ACS in this population. This highlights the importance of both COPD and infection severity on risk of ACS following hospitalisation with aLRTI.
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| Concepts | Keywords |
|---|---|
| 100inpatient | Acs |
| 30days | Acute |
| Drivers | Adults |
| Hospitalisation | Alrti |
| Pneumonia | Cardiovascular |
| Cohort | |
| Copd | |
| Day | |
| Diagnosis | |
| Factors | |
| Hospitalised | |
| Infection | |
| Pneumonia | |
| Risk | |
| Severity |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Acute coronary syndrome |
| disease | MESH | COPD |
| disease | MESH | cardiovascular disease |
| disease | MESH | infection |
| disease | MESH | included |
| disease | MESH | pneumonia |