Clinically Relevant Patterns of Cardiovascular Comorbidities in Patients with COPD: Do They Matter at All?

  • Borislav Božanić Clinic for Pulmonary Diseases, Clinical Center Niš, Serbia
Keywords: inflammation, cardiovascular disease, chronic obstructive pulmonary disease, Cardiovascular System,

Abstract


The association of chronic obstructive pulmonary disease and cardiovascular disease was observed during the study of the systemic effects of this disease. Among these patients, the incidence, but also the mortality from cardiovascular disease is significantly higher, while the reduction of cardiovascular risk is an important target for the reduction of overall mortality from COPD.

The complex pathophysiological mechanisms of the interaction of the respiratory and cardiovascular system during COPD exacerbation have not yet been sufficiently studied, but their clinical manifestations are an increasing challenge within modern diagnostics and therapy. Studies have shown that intensification of systemic inflammatory response in acute exacerbation of COPD results in endothelial dysfunction, activation of atherosclerotic plaques, increased susceptibility to rupture and thrombus formation, which is indirect, but very significant cause of acute cardiovascular events.

Acute exacerbations of COPD can be triggers for acute cardiovascular event, as well as they can be triggered by previous cardiovascular events. Despite an improved diagnostic-therapeutic procedure, this two-way association often remains unrecognized. The effect of COPD treatment on the coexisting vulnerability of the cardiovascular system is still not fully understood.

Despite the reliable evidence confirming the link between COPD and cardiovascular disease, modern therapeutic options for targeted treatment of these diseases are still in the testing phase, with no more relevant randomized clinical trials in this field. The first results of the SUMMIT study promise a more appropriate treatment of these patients.

References

Anthonisen NR, Connett JE, Enright PL et al. Hospitalizations and mortality in the lung health study. Am J Respir Crit Care Med 2002; 166(3): 333–9. doi: 10.1164/rccm.2110093

Appleton S, Jones T, Poole P et al. Ipratropium bromide versus short acting beta-2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006; (3): CD001387. doi: 10.1002/14651858.CD006101

Bertoletti L, Quenet S, Mismetti P et al. Clinical presentation and outcome of venous thromboembolism in COPD. Eur Respir J 2012; 39: 862-8. doi: 10.1183/09031936.00058811

Boschetto P, Beghe B, Fabbri LM et al. Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice. Respirology 2012; 17: 422-31. doi: 10.1111/j.1440-1843.2011.02118.x

Brekke PH, Omland T, Smith P et al. Underdiagnosis of myocardial infarction in COPD - Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation. Respir Med 2008; 102: 1243-7. doi: 10.1016/j.rmed.2008.04.010

Bursi F, Vassallo R, Weston SA et al. Chronic obstructive pulmonary disease after myocardial infarction in the community. Am Heart J 2010; 160(1): 95–101. doi: 10.1016/j.ahj.2010.05.004

Calverley PMA, Anderson JA, Celli B et al. Cardiovascular events in patients with COPD: TORCH Study results. Thorax 2010; 65: 719-25. doi: 10.1136/thx.2010.136077

Camiciottoli G, Bigazzi F, Magni C et al. Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease. Int J Chronic Obstruct Pulm Dis 2016; 11: 2229–36. doi: 10.2147/COPD.S111724

Cao C, Wang R, Wang J et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One 2012; 7: 1–8. doi: 10.1371/journal.pone.0043892

Cui H, Miao DM, Wei MZ et al. Prevalence of cardiovascular disease in subjects hospitalized due to chronic obstructive pulmonary disease in Beijing from 2000 to 2010. J Geriatr Cardiol 2012; 9(1): 5–10. doi: 10.3724/SP.J.1263.2012.00005

Ćirić Z, Stanković I, Pejčić T et al. Nutrition disorders and systemic inflamation in patients with chronic obstructive pulmonary disease. Med Glas 2013; 10(2): 266-71. PMID: 23892843

Decramer ML, Hanania NA, Lotvall JO et al. The safety of long-acting beta2-agonists in the treatment of stable chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8: 53-64. doi: 10.2147/COPD.S39018

De Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM et al. Cardiovascular risk factors in chronic obstructive pulmonary disease: results of the ARCE study. Arch Bronconeumol 2008; 44: 233-8. doi: 10.1157/13119937

Diez-Manglano J, Barquero-Romero J, Almagro P et al. COPD patients with and without metabolic syndrome: clinical and functional differences. Intern Emerg Med 2014; 9(4): 419-25. doi: 10.1007/s11739-013-0945-7

Divo M, Cote C, De Torres JP et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 186(2): 155-61. doi: 10.1164/rccm.201201-0034OC

Donaldson GC, Hurst JR, Smith CJ et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010; 137(5): 1091-7. doi: 10.1378/chest.09-2029

Etminan M, Jafari S, Carleton B et al. Beta-blocker use and COPD mortality: a systematic review and meta-analysis. BMC Pulm Med 2012; 12: 48. doi: 10.1186/1471-2466-12-48

Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 2009; 4: 337–49. doi: 10.2147/COPD.S6400

Ford ES, Wheaton AG, Mannino DM et al. Elevated cardiovascular risk among adults with obstructive and restrictive airway functioning in the United States: a cross-sectional study of the National Health and Nutrition Examination Survey from 2007–2010. Respir Res 2012; 13(1): 115. doi: 10.1186/1465-9921-13-115

Garcia-Olmos L, Alberquilla A, Ayala V et al. Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC Fam Pract 2013; 14: 11. doi: 10.1186/1471-2296-14-11

Held C, Iqbal C, Lear SA et al. Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study. Eur Heart J 2012; 33(4): 452-66. doi: 10.1093/eurheartj/ehr432

Hogg JC, Timens W. The pathology of chronic obstructive pulmonary disease. Annu Rev Pathol 2009; 4: 435–459. doi: 10.1146/annurev.pathol.4.110807.092145

Huiart L, Ernst P, Ranoui X et al. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634-9. doi: 10.1183/09031936.05.00079004

Kido T, Tamagawa E, Bai N et al. Particulate matter induces translocation of IL-6 from the lung to the systemic circulation. Am J Respir Cell Mol Biol 2011; 44(2): 197–204. doi: 10.1165/rcmb.2009-0427OC

Lahousse L, Loth DW, Joos GF et al. Statins, systemic inflammation and risk of death in COPD: the Rotterdam study. Pulm Pharmacol Ther 2013; 26: 212-7. doi: 10.1016/j.pupt.2012.10.008

Mancini GBJ, Etminan M, Zhang B et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47(12): 2554–60. doi: 10.1016/j.jacc.2006.04.039

Marchetti N, Ciccolella DE, Jacobs MR et al. Hospitalized acute exacerbation of COPD impairs flow and nitroglycerin mediated peripheral vascular dilation. COPD 2011; 8(2): 60–5. doi: 10.3109/15412555.2011.558541

McMurray JJ, Adamopoulos S, Anker SD et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur Heart J 2012; 33(14): 1787–847. doi: 10.1093/eurheartj/ehs104

Morgan AD, Zakeri R, Quint JK. Defining the relationship between COPD and CVD: what are the implications for clinical practice? Ther Adv Respir Dis 2018; 12: 1-16. doi: 10.1177/1753465817750524

Mortensen EM, Copeland LA, Pugh MJV et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45. doi: 10.1186/1465-9921-10-45

Mullerova H, Agusti A, Erqou S et al. Cardiovascular comorbidity in chronic obstructive pulmonary disease: systematic literature review. Chest 2013; 144: 1163-78. doi: 10.1378/chest.12-2847

O’Donnell CJ, Elosua R. Cardiovascular risk factors. Insights from framingham heart study. Rev Esp Cardiol 2008; 61(3): 299–310. doi: 10.1016/S1885-5857(08)60118-8

Poulain M, Doucet M, Major GC et al. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. CMAJ 2006; 174: 1293–9. doi: 10.1503/cmaj.051299

Schnell K, Weiss CO, Lee T et al. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999-2008. BMC Pulm Med 2012; 12: 26. doi: 10.1186/1471-2466-12-26

Sevenoaks MJ, Stockley RA. Chronic obstructive pulmonary disease, inflammation and co-morbidity–a common inflammatory phenotype. Respir Res 2006; 7: 70. doi: 10.1186/1465-9921-7-70

Singh D, Agusti A, Anzueto A et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J 2019; 53(5): pii: 1900164. doi: 10.1183/13993003.00164-2019

Stanković I, Ćirić Z, Radović M. Asthma exacerbations and viruses. Acta Fac Med Naiss 2011; 28(4): 241-44. UDC:616.211-002:616.248

Radović M, Ristić L, Ćirić Z et al. Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection. Int J Chron Obstruct Pulmon Dis 2016; 11(1): 1307-16. doi: 10.2147/COPD.S106875

Reed RM, Eberlein M, Girgis RE et al. Coronary artery disease is under-diagnosed and under-treated in advanced lung disease. Am J Med 2012; 125(12): 1228.e13-1228.e22. doi: 10.1016/j.amjmed.2012.05.018

Roca M, Verduri A, Corbetta L et al. Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease. Eur J Clin Invest 2013; 43: 510- 21. doi: 10.1111/eci.12064

Roversi S, Roversi P, Spadafora G et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44 (1): 93-100. doi: 10.1111/eci.12181

Quint J. The Relationship between COPD and Cardiovascular Disease. Tanaffos 2017; 16(Suppl 1): S16-S17. PMID: 29158754

Van Eeden SF, Sin DD. Chronic obstructive pulmonary disease: a chronic systemic inflammatory disease. Respiration 2008; 75(2): 224–38. doi: 10.1159/000111820

Vestbo J, Anderson J, Brook RD et al. The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol. Eur Respir J 2013; 41: 1017-22. doi: 10.1183/09031936.00087312

Yuji H, Toshiyuki Y, Noritsugu H et al. Clinical and inflammatory factors associated with body mass index in elderly patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2011; 11(1): 32–38. doi: 10.1111/j.1447-0594.2010.00629.x

Published
2025/12/22
Section
Pregledni rad / Review article