Excess risk of major vascular diseases associated with airflow obstruction: a 9-year prospective study of 0.5 million Chinese adults

Om P Kurmi, Liming Li, Kourtney J Davis, Jenny Wang, Derrick A Bennett, Ka Hung Chan, Ling Yang, Yiping Chen, Yu Guo, Zheng Bian, Junshi Chen, Liuping Wei, Donghui Jin, Rory Collins, Richard Peto, Zhengming Chen

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Background: China has high COPD rates, even among never-regular smokers. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults.

Objective: We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality.

Materials and methods: In 2004-2008, a nationwide prospective cohort study recruited 512,891 men and women aged 30-79 years from 10 diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalization for 9 years. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without.

Results: Of 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21-1.36). There were also increased risks of hemorrhagic stroke (n=823, HR 1.18, 95% CI 1.09-1.27), major coronary events (n=635, HR 1.33, 95% CI 1.22-1.45), and heart failure (n=543, HR 2.19, 95% CI 1.98-2.41). For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers.

Conclusion: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis.

Original languageEnglish
Pages (from-to)855-865
Number of pages11
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Publication statusPublished - 8 Mar 2018
Externally publishedYes

Bibliographical note

This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at http://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Adult
  • Aged
  • Airway Obstruction/diagnosis
  • Cardiovascular Diseases/diagnosis
  • Chi-Square Distribution
  • China/epidemiology
  • Comorbidity
  • Forced Expiratory Volume
  • Humans
  • Lung/physiopathology
  • Middle Aged
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Risk Assessment
  • Risk Factors
  • Smoking/adverse effects
  • Spirometry
  • Time Factors
  • Vital Capacity


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