Background: Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) greatly influence morbidity and mortality, with COPD patients frequently suffering from cardiovascular comorbidities like coronary heart disease and stroke. This study analyzes mortality trends and disparities among individuals in the United States (US) affected by both CVD and COPD. Methods: This study analyzed death certificates from the CDC WONDER database for individuals aged 25 and older who died between 1999 and 2020 with both CVD (ICD I00-I99) and COPD (ICD J41-J44). Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age group, race/ethnicity, geographic region, and urbanization status. Results: Between 1999 and 2020, there were 3,590,124 reported deaths due to coexisting CVD and COPD, with overall AAMR slightly changing from 82.2 to 81.2 per 100,000 population, and a notable rise from 2018 to 2020 (APC: 5.28; 95% CI: 1.83 to 7.22) coinciding with the onset of COVID-19 pandemic. A similar surge in mortality was observed across multiple demographic subgroups, particularly among older adults. Disparities across age groups, sex, race, and geographic location were also observed in the mortality rates due to CVD and COPD. When analyzed by age group, older adults exhibited the highest AAMR at 824.1. Men had higher AAMRs than women (96.5 vs. 60.7). Ethnoracial analysis showed that non-Hispanic (NH) White individuals had the highest AAMRs (82.0), followed by NH American Indian or Alaska Native (74.5), NH Black (63.6), Hispanic (38.1), and NH Asian or Pacific Islander (25.1) individuals. Additionally, non-metropolitan areas had higher AAMRs compared to metropolitan areas (96.2 vs. 70.9). Conclusions: The findings suggest that mortality rates for CVD and COPD have increased in recent years, coinciding with the onset of the COVID-19 pandemic, which may have exacerbated outcomes in vulnerable populations. The study highlights the need for targeted interventions to address the overlapping impacts of CVD and COPD, especially in high-risk groups.

Background: Many hemodynamic parameters provide limited information regarding obstructive coronary artery disease (CAD) during exercise stress testing particularly when exercise is suboptimal. Hemodynamic gain index (HGI) is a recent sensitive indicator of ischemia and has been associated with increased mortality. This study evaluated the clinical impact of HGI in patients who underwent concomitant exercise stress testing and coronary computed tomography angiography (CCTA). Methods: A total of 284 consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) as well as systolic blood pressure (SBP) measurements were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI $$(\frac{{{\text{HRpeak}} \times {\text{SBPpeak}} - {\text{HRrest}} \times {\text{SBPrest}}}}{{{\text{HRrest}} \times {\text{SBPrest}}}})$$( HRpeak × SBPpeak - HRrest × SBPrest HRrest × SBPrest ) were calculated. The latter was divided into quartiles. CCTA was used as a reference test to detect any CAD. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD. Results: Mean age was 53 ± 12 years with 83% male. Mean HGI was 1.74 ± 0.67, with cut-off value of severely blunted HGI ≤ 1.25 (Quartile 4). Patients with severely blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD had lower HGI when compared to those with normal CCTA/non-obstructive CAD (1.36 ± 0.53 vs. 1.77 ± 0.67, P = 0.005), and showed a higher prevalence of severely blunted HGI (44% vs. 22%, P = 0.019). After adjusting for traditional risk factors, HGI remained an independent predictor of obstructive CAD while severely blunted HGI was associated with threefold increased odds of having obstructive CAD (P = 0.05). Using artificial intelligence analysis, severely blunted HGI independently predicted obstructive CAD with an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models. Conclusions: Among patients who underwent concomitant exercise stress testing and CCTA, severely blunted HGI independently predicted obstructive CAD after multivariate adjustment for traditional risk factors.