Joint Association of Questionnaire-Defined COPD and Widened Pulse Pressure with Incident Cardiovascular Disease in Older Chinese Adults: A 7-Year CHARLS Cohort Study.
Liu G, Zou Y, Zhou Y • International journal of chronic obstructive pulmonary disease • 2026
Coexisting questionnaire-defined COPD and widened pulse pressure was associated with a higher risk of incident cardiovascular disease, primarily reported heart disease, and with higher all-cause mortality than neither exposure, although mortality was not clearly higher than among participants with COPD alone.
Key Findings
Results
The combination of questionnaire-defined COPD and widened pulse pressure was associated with significantly higher incident cardiovascular disease risk, whereas either exposure alone was not.
Study population: 4183 CHARLS participants aged 60 years or older without baseline heart disease or stroke
943 participants developed incident cardiovascular disease over the 7-year follow-up
Both exposures combined: adjusted HR 1.86 (95% CI 1.26–2.76) versus neither exposure
Weighted cause-specific Cox models used respondent weights and household-cluster robust standard errors
Results
The joint association of COPD and widened pulse pressure with cardiovascular disease was driven by heart disease but not stroke.
Heart disease component outcome for the both-exposure group: HR 2.80 (95% CI 1.94–4.05)
Stroke component outcome for the both-exposure group: HR 0.84 (95% CI 0.43–1.65), not statistically significant
Authors note that 'the composite cardiovascular signal should therefore not be read as a uniform effect across cardiovascular systems'
Primary outcome was incident physician-reported heart disease or stroke combined
Results
The both-exposure group had significantly higher all-cause mortality compared to the neither-exposure group, but mortality was not clearly higher than in the COPD-only group.
685 total deaths occurred across the study population over follow-up
Both-exposure group had 63 deaths among 209 participants
Fully adjusted HR for all-cause mortality in both-exposure group versus neither: 2.05 (95% CI 1.54–2.73)
Mortality comparison of both-exposure group versus COPD-only group: HR 1.37 (95% CI 0.96–1.95), confidence interval crossing 1
Methods
Widened pulse pressure was defined as 60 mmHg or greater and was used as a marker of vascular aging to form four phenotypic groups alongside questionnaire-defined COPD.
Four phenotypes formed: neither exposure, COPD alone, widened pulse pressure alone, and both exposures
Widened pulse pressure threshold set at ≥60 mmHg
COPD was defined by questionnaire rather than spirometry
The joint phenotype was selected after an exploratory screen of candidate vascular indicators, making findings hypothesis-generating rather than confirmatory
Discussion
The study identified that COPD and vascular aging (widened pulse pressure) frequently coexist in older adults, and their co-occurrence may identify a particularly high cardiovascular risk subgroup.
The both-exposure group comprised 209 of the 4183 participants
Authors note that 'widened pulse pressure identifies older adults with COPD at particularly high cardiovascular risk'
Study used data from the China Health and Retirement Longitudinal Study (CHARLS) with a 7-year follow-up
Authors call for 'external validation using objective pulmonary and vascular measures'
What This Means
This research suggests that among older Chinese adults (aged 60 and above), having both a questionnaire-based diagnosis of COPD (a chronic lung disease) and high pulse pressure — a measure of blood vessel stiffness calculated as the difference between systolic and diastolic blood pressure — at the same time is associated with nearly double the risk of developing cardiovascular disease compared to having neither condition. Importantly, having either condition alone was not associated with a statistically meaningful increase in cardiovascular risk, suggesting that it is the combination of these two factors that may be particularly dangerous. The increased cardiovascular risk appeared to be specifically driven by heart disease rather than stroke.
The study followed over 4,000 older adults without pre-existing heart disease or stroke for seven years as part of the China Health and Retirement Longitudinal Study (CHARLS). People with both COPD and high pulse pressure also had roughly twice the risk of dying from any cause compared to those with neither condition, though their mortality risk was not clearly higher than those with COPD alone. The researchers note that pulse pressure of 60 mmHg or higher served as a marker of vascular aging, and that the co-occurrence of lung disease and blood vessel stiffening may define a particularly vulnerable group.
This research suggests that checking blood pressure readings — which are routinely collected — could help identify older adults with COPD who face the highest cardiovascular risk. However, the authors emphasize that these findings are hypothesis-generating rather than confirmatory, because the analysis was exploratory in design. The COPD diagnosis was based on questionnaires rather than breathing tests, and the study was conducted in one country, so these results need to be validated in other populations using more objective measures of lung and blood vessel health before strong conclusions can be drawn.
Liu G, Zou Y, Zhou Y. (2026). Joint Association of Questionnaire-Defined COPD and Widened Pulse Pressure with Incident Cardiovascular Disease in Older Chinese Adults: A 7-Year CHARLS Cohort Study.. International journal of chronic obstructive pulmonary disease. https://doi.org/10.2147/COPD.S640995