Background
Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular disease and chronic kidney disease, but with conflicting estimates. We aimed to quantify the association of COPD and incident cardiovascular diseases, chronic kidney disease and death.
Methods
In this systematic review and meta-analysis, we searched MEDLINE and Embase for case-control studies reporting associations between COPD and cardiovascular diseases, chronic kidney disease and death from database inception until 15 April 2026. Two reviewers independently extracted study characteristics and reported risk ratios of incident outcomes associated with COPD, specifically: atrial fibrillation and flutter, ventricular fibrillation and tachycardia, myocardial infarction, ischaemic stroke, heart failure, peripheral arterial disease, chronic kidney disease, cardiovascular mortality and all-cause mortality. Pooled estimates were obtained using random-effects models with restricted maximum likelihood estimation as substantial heterogeneity was anticipated. Ten sensitivity analyses stratifying studies by design, follow-up duration, region, clinical context, sample size, publication date, COPD ascertainment, leave-one-out, ratio adjustment and risk of bias, subgroup analyses by age and risk group were undertaken, and subsequent univariate and multivariate meta regression was performed. Study quality was assessed using the risk of bias in non-randomised follow-up studies of exposure effects (ROBINS-E) tool, and certainty of evidence was assessed using Grading of Assessment, Evaluation, Development and Evaluation (GRADE) criteria. Risk of publication bias was assessed using funnel plots and Egger’s regression. This review was registered on PROSPERO (CRD42025639084).
Findings
Of 140 case-control studies including 30,144,481 patients (3,062,712 with COPD) with median follow -up duration of 3.0 years (IQR 1.0–5.2), COPD was associated with increased risk of heart failure (risk ratio [RR] 2.33, 95% CI 1.78–3.06), ventricular tachycardia (2.05, 1.27–3.31), peripheral arterial disease (1.99, 1.49–2.65), heart failure hospitalisation (1.78, 1.28–2.47), chronic kidney disease (1.65, 1.25–2.16), all-cause mortality (1.55, 1.42–1.70), cardiovascular mortality (1.55, 1.33–1.82), myocardial infarction (1.47, 1.28–1.68), ischaemic stroke (1.38, 1.18–1.62), and atrial fibrillation (1.38, 1.19–1.61) when compared to those without COPD. Despite substantial heterogeneity for all outcomes, associations between COPD and outcomes were broadly consistent across sensitivity analyses.
Interpretation
COPD is associated with an increased risk for a range of incident cardiovascular diseases, chronic kidney disease and mortality. The impact of current and novel treatments on a broader range of cardiovascular and kidney outcomes in patients with COPD requires prospective randomised assessment.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)