Klinički relevantni obrasci kardiovaskularnih komorbiditeta kod pacijenata sa HOBP: da li su isti uopšte važni?

  • Borislav Božanić Klinika za plućne bolesti, Klinički centra Niš, Niš, Srbija
Ključne reči: inflammation||, ||inflamacija, cardiovascular disease||, ||kardiovaskularna bolest, chronic obstructive pulmonary disease||, ||hronična opstruktivna bolest pluća, Cardiovascular System||, ||kardiovaskularni sistem,

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.

 

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Objavljeno
2020/06/25
Rubrika
Pregledni rad / Review article