Prevalence of Airflow Limitation in Patients with Ischemic Heart Disease in Kashmir

Background: Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and is a leading global cause of morbidity and mortality[1]. COPD often coexists with cardiovascular disease, sharing risk factors such as smoking; however, COPD may remain undiagnosed in patients with ischemic heart disease (IHD)[2]. The burden of COPD among IHD patients in Kashmir is not well-defined. Aim: To determine the prevalence of airflow limitation (COPD) in patients with stable IHD and compare it with age- and sex-matched controls without IHD. Materials and Methods: In this case-control study at a tertiary care center in Srinagar (Dec 2020–Mar 2021), 158 patients ≥40 years with angiographically documented stable IHD were enrolled along with 158 age- and sex-matched controls without IHD[3]. Exclusion criteria included contraindications to spirometry or recent myocardial infarction, surgery, infection, or stroke (within defined timeframes)[4]. All subjects underwent spirometry (ndd EasyOne spirometer) following ATS/ERS standards, before and after bronchodilator. COPD was defined as post-bronchodilator FEV ₁ /FVC <70%[5][6]. Body mass index (BMI) and smoking history were recorded. Ethical clearance was obtained from the institutional ethics committee. Results: The case and control groups were similar in age and gender (mean age ~60 years; ~70% male)[7][8]. In cases, 50% were obese (BMI >25) versus 72.1% of controls (p<0.001)[9][10]. Current smoking was more common in IHD patients (60.1% vs 48.7% in controls; p≈0.055)[11]. Airflow limitation was detected in 31.0% of IHD patients (49/158) compared to 12.0% of controls (19/158)[12][13]. Among those with airflow limitation, the majority had moderate obstruction (GOLD stage 2) in both cases (44.9%) and controls (42.1%). The odds ratio for COPD in IHD versus non-IHD was 3.28 (95% CI 1.83–5.90, p<0.001). Notably, over 90% of IHD patients with airflow limitation were previously undiagnosed. Conclusion: Airflow limitation (COPD) is significantly more prevalent in stable IHD patients than in matched controls in Kashmir, with most cases undetected by routine care. These findings underscore the need for systematic spirometric screening for COPD in patients with IHD to enable early diagnosis and integrated management.