In Patients with Mild-to-Moderate COPD, Tobacco Smoking, and Not COPD, Is Associated with a Higher Risk of Cardiovascular Comorbidity

Thibaud Soumagne,1 Alicia Guillien,2 Nicolas Roche,3 Isabella Annesi-Maesano,4 Pascal Andujar,5,6 Lucie Laurent,1 Stéphane Jouneau,7,8 Martial Botebol,9 Jean-Jacques Laplante,10 Jean-Charles Dalphin,1,11 Bruno Degano12,13 1Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, Besançon, France; 2Equipe d’Epidémiologie Environnementale, Institute for Advanced Biosciences, Centre de Recherche UGA, INSERM U1209, CNRS UMR 5309, Grenoble, France; 3Service de Pneumologie, Groupe Hospitalier Cochin, Site Val de Grâce, AP-HP and Université Paris Descartes (EA2511), Sorbonne-Paris-Cité, Paris, France; 4Epidemiology of Allergic and Respiratory Diseases UMR-S 707 Inserm/UPMC, Université Paris 6, Paris, France; 5Centre Hospitalier Intercommunal de Créteil, Service de Pathologie Professionnelle et de l’Environnement, Créteil, France; 6Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; 7Service de Pneumologie, CHU de Rennes, Rennes, France; 8Univ Rennes, CHU Rennes, Inserm, EHESP, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR-S 1085, Rennes, France; 9Fédération des Maisons de Santé Comtoises (FéMaSaC), Beure, France; 10Mutualité Sociale Agricole (MSA), Besançon, France; 11UMR CNRS Chrono Environnement, Université de Franche-Comté, Besançon, France; 12Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble, Alpes, France; 13Université Grenoble Alpes, INSERM U 1042, Grenoble, FranceCorrespondence: Thibaud Soumagne Email thibaud_soumagne@live.frBackground: Comorbidities including cardiovascular diseases are very common in chronic obstructive pulmonary disease (COPD) secondary to tobacco smoking and contribute to the overall severity of the disease. In non-smoking COPD, which accounts for about 25% of COPD cases worldwide, current knowledge on the frequency and determinants of comorbidities remains scarce. The aims of the current study were to assess the frequency of major comorbidities and to evaluate their determinants in a group of non-selected patients with mild-to-moderate COPD who were exposed to organic dust (dairy farmers), to tobacco smoking, or to both, and in controls without COPD who were exposed to organic dust (dairy farmers), or to tobacco smoking, or to both, or who were without exposure.Patients and Methods: A total of 4665 subjects (2323 dairy farmers and 2342 non-farmers) including 355 patients with COPD and 4310 controls with normal spirometry were recruited through a large COPD screening program. Self-reported physician-diagnosed diseases with plausible links to COPD were recorded in this cross-sectional study.Results: Whatever the exposure, cardiovascular comorbidities were not more frequent in patients with COPD than their counterparts without airflow limitation. A higher risk of major cardiovascular comorbidities was associated with tobacco smoking and a lower risk was associated with exposure to organic dusts.Conclusion: Tobacco smoking (but not COPD) is associated with higher frequency of cardiovascular comorbidities. By contrast, being a dairy farmer exposed to organic dusts is associated with a lower frequency of the same comorbidities. This reinforces the crucial need for controlling established cardiovascular risk factors even in patients with mild-to-moderate COPD.Keywords: cardiovascular diseases, chronic obstructive pulmonary disease, comorbidity, diabetes mellitus, tobacco smoking