Chronic obstructive pulmonary disease increases the risk of cardiovascular disease occurrence in nonsmokers: A nationwide cohort study

Why clinicians should know about it

• Picked for Epidemiology (paper of the day, 17 October 2026): Nationwide cohort of COPD and cardiovascular disease risk in never‑smokers

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is among the leading causes of mortality worldwide, and patients experience a high prevalence of concomitant cardiovascular diseases (CVDs). In this study, we aimed to determine whether never smokers with COPD exhibit an increased risk of CVD compared with those without COPD and whether this risk parallels that observed in smokers with COPD. METHODS: We conducted a prospective cohort study using data from the China Kadoorie Biobank (CKB). Spirometry was performed on all the participants, and COPD was defined as the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) <0.7. Eligible participants in our study were free of diagnosed CVDs, including ischemic heart disease, heart failure, hypertension, or atrial fibrillation at baseline. The clinical outcomes were the incidences of these 4 CVDs and their overall incidence during follow-up. Cox proportional hazard models were used to estimate the associations of COPD and smoking status with incident CVD outcomes. RESULTS: Among all eligible participants (n = 366,161, 20,887 with COPD), 40,861 incident cases of CVD events were observed during a median follow-up time of 10 years. Compared with never smokers without COPD, those with COPD exhibited a significantly higher risk of overall CVD, with hazard ratios (HRs) of 1.23 (95% CI: 1.09-1.39) for men and 1.24 (95% CI: 1.17-1.31) for women. Among male COPD participants, the incidence rates of overall CVD, ischemic heart disease, and hypertension, but not that of heart failure, were similar between never smokers and smokers. In contrast, female COPD participants who never smoked exhibited lower risks across all cardiovascular endpoints compared with their smoking counterparts. These results remained unchanged after propensity score matching. CONCLUSION: In never smokers, COPD per se serves as an independent risk factor for CVD. Among men with COPD, smoking exposure confers no added hazard, whereas women with COPD who smoke remain at higher risk for CVD than their never-smoking counterparts.

Abstract as published, via PubMed.