Cardiovascular risk in Chronic Obstructive Lung Disease
Presented by Oskar Wallström, Sweden
OPPSUMMERING Forekomst av kardiovaskulær sykdom er betraktelig høyere hos personer med KOLS og gir også en signifikant risiko for fremtidige sykehusinnleggelser hos KOLS-pasienter. På den annen side øker risikoen for kardiovaskulære hendelser betraktelig ved KOLS-forverringer. Sammenhengen mellom kardiovaskulær sykdom og KOLS gjør at pasienten trenger en helhetlig behandling fremfor separat behandling av sykdommene sine.
COPD and Cardiovascular Disease – Overlapping Risk Factors
COPD is a prevalent chronic disease and the third leading cause of death globally, accounting for more than 3 million deaths annually (WHO, 2019). Prevalence of cardiovascular disease (CVD) is notably higher in COPD patients, reflecting a complex interplay between CVD and COPD due to shared risk factors, pathophysiology, and symptoms1.
CVD as a Risk Factor for Hospitalization in COPD
CVD has been identified as a significant risk factor for future hospitalization in COPD patients, independent of the severity of their lung disease2. This highlights the need for comprehensive cardiovascular care in managing COPD patients.
Exacerbations may trigger Cardiovascular Events
There is mounting evidence that COPD patients are particularly vulnerable to cardiovascular events during periods of exacerbation. For instance, Donaldson et al. (2010) demonstrated that the risk of myocardial infarction is significantly increased during the initial 1 to 5 days following an exacerbation compared to periods without exacerbation3. Along with findings indicating an elevated risk extending up to one year after an exacerbation4, the necessity of close monitoring of COPD patients may last for one year post-exacerbation.
Heart Failure: A Common Condition in COPD
Considering its high prevalence, COPD patients should be assessed for heart failure. Various diagnostic tools are available for clinical examination, with particular emphasis on pro-BNP and troponin levels, which have been associated with poor prognosis in these patients.
Triple Therapy and Cardiovascular Risk
It is well-established that triple therapy—combining corticosteroids, long-acting beta-agonists, and long-acting muscarinic antagonists—reduces exacerbations and hospitalizations, improves lung function, and enhances quality of life in COPD patients compared to dual therapy5-8. However, the effect of triple treatment on cardiovascular events and the risk of premature death remains to be elucidated. Several post-hoc analyses of phase-III trials, although not specifically powered to examine mortality, have suggested a decreased risk of all-cause mortality with triple treatment9-11. These findings should be interpreted with caution due to the exploratory nature of the studies.
Take Home Message
- By understanding and addressing the cardiovascular risks associated with COPD, healthcare providers can improve overall patient outcomes and quality of life.
Emil BOJSEN-MØLLER
Medical Science Liaison
References:
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ID 8699-18.06.2024