Klinički relevantni obrasci kardiovaskularnih komorbiditeta kod pacijenata sa HOBP: da li su isti uopšte važni?
Sažetak
Udruženost HOBP i kardiovaskularnih bolesti uočena je tokom proučavanja sistemskih posledica ove bolesti. Među obolelima značajno je veća incidenca, ali i mortalitet od kardiovaskularnih bolesti, dok redukcija kardiovaskularnog rizika predstavlja važno polje za redukciju sveukupnog mortaliteta od HOBP. Kompleksni patofiziološki mehanizmi interakcije respiratornog i kardiovaskularnog sistema tokom akutizacije HOBP još uvek nisu dovoljno proučeni, a njihova klinička ispoljavanja predstavljaju sve veći izazov u sklopu savremene dijagnostike i terapije. Studije pokazuju da intenziviranje sistemskog inflamatornog odgovora u akutnoj egzacerbaciji HOBP rezultuje endotelnom disfunkcijom, aktivacijom aterosklerotskih plakova, većom podložnošću ka rupturi i formiranju tromba, što je posredan, ali veoma značajan, uzrok akutnih kardiovaskularnih događaja. Akutna pogoršanja HOBP mogu biti okidači za akutni kardiovaskularni događaj, ali i sami biti pokrenuti prethodnim kardiovaskularnim dešavanjem. Uprkos unapređenim dijagnostičko-terapijskim postupcima, ova dvosmerna povezanost često ostaje neprepoznata. Efekat tretmana HOBP na koegzistirajuću vulnerabilnost kardiovaskularnog sistema još uvek nije u potpunosti razjašnjen. I pored sigurnih dokaza koji potkrepljuju vezu između HOBP i kardiovaskularnih bolesti, savremene terapijske opcije ciljanog lečenja ovih bolesti još uvek su u fazi ispitivanja, bez relevantnijih randomizovanih kliničkih ispitivanja na ovu temu. Prvi rezultati SUMMIT studije obećavaju adehvatniji tretman ovih pacijenata.
Reference
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