Answer: E. The prevalence and incidence of stroke are clearly increased in people with COPD; however, there is insufficient evidence to support that COPD is an independent risk factor for stroke.


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Although the prevalence and incidence of stroke are clearly increased in patients with COPD, and several studies have suggested that COPD is a risk factor for a stroke developing, more recent studies have not supported those claims.1

In fact, the association between stroke and COPD remains much weaker than the association between COPD and myocardial infarction. When adjustments are made for smoking, which is a major independent risk factor for both COPD and stroke, the association suggesting a causal relationship between COPD and stroke is markedly reduced.1,2

These findings suggest that smoking is a shared risk factor that drives the increased risk for stroke that was attributed to COPD in previous studies.2 Thus, answer E is correct. Although patients with COPD appear to be at higher risk for stroke, that risk is driven by comorbidities rather than by COPD itself.1

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  1. Morgan AD, Sharma C, Rothnie KJ, Potts J, Smeeth L, Quint JK. Chronic obstructive pulmonary disease and the risk of stroke. Ann Am Thorac Soc. 2017;14(5):754-765.
  2. Goudis CA, Konstantinidis AK, Ntalas IV, Korantzopoulos P. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease. Int J Cardiol. 2015;199:264-273.

This article originally appeared on Pulmonology Advisor