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Chronic Obstructive Pulmonary Disease and Ischemic Heart Disease Comorbidity: Overview of Mechanisms and Clinical Management

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Abstract

In the last few years, many studies focused their attention on the relationship between chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD), showing that these diseases are mutually influenced. Many different biological processes such as hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, arterial stiffness and right ventricle modification interact in the development of the COPD-IHD comorbidity, which therefore deserves special attention in early diagnosis and treatment. Patients with COPD-IHD comorbidity have a worst outcome, when compared to patients with only COPD or only IHD. These patients showed a significant increase on risk of adverse events and of hospital readmissions for recurrent myocardial infarction, heart failure, coronary revascularization, and acute exacerbation of COPD. Taken together, these complications determine a significant increase in mortality. In most cases death occurs for cardiovascular cause, soon after an acute exacerbation of COPD or a cardiovascular adverse event. Recent data regarding incidence, mechanisms and prognosis of this comorbidity, along with the development of new drugs and interventional approaches may improve the management and long-term outcome of COPD-IHD patients. The aim of this review is to describe the current knowledge on COPD-IHD comorbidity. Particularly, we focused our attention on underlying pathological mechanisms and on all treatment and strategies that may improve and optimize the clinical management of COPD-IHD patients.

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References

  1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated 2014.

  2. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 2014 ESC/EACTS guidelines on myocardial revascularization. Eurointervention 2014.

  3. Curkendall SM, DeLuise C, Jones JK, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16:63–70.

    Article  PubMed  Google Scholar 

  4. Feary JR, Rodrigues LC, Smith CJ, et al. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65:956–62.

    Article  PubMed  Google Scholar 

  5. American Thoracic Society/European Respiratory Society Task Force. Standards for the diagnosis and management of patients with COPD. New York: American Thoracic Society; 2004.

    Google Scholar 

  6. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28:523–32.

    Article  CAS  PubMed  Google Scholar 

  7. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet. 2007;370:741–50.

    Article  PubMed  Google Scholar 

  8. Menezes AM, Perez-Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005;366:1875–81.

    Article  PubMed  Google Scholar 

  9. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442–62.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Soriano JB, Visick GT, Muellerova H, et al. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest. 2005;128:2099–107.

    Article  PubMed  Google Scholar 

  11. Berger JS, Sanborn TA, Sherman W, Brown DL. Effect of chronic obstructive pulmonary disease on survival of patients with coronary heart disease having percutaneous coronary intervention. Am J Cardiol. 2004;94:649–51.

    Article  PubMed  Google Scholar 

  12. Bursi F, Vassallo R, Weston SA, et al. Chronic obstructive pulmonary disease after myocardial infarction in the community. Am Heart J. 2010;160:95–101.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Selvaraj CL, Gurm HS, Gupta R, Ellis SG, Bhatt DL. Chronic obstructive pulmonary disease as a predictor of mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2005;96:756–9.

    Article  PubMed  Google Scholar 

  14. Enriquez JR, Parikh SV, Selzer F, et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute dynamic registry. Chest. 2011;140:604–10.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Campo G, Guastaroba P, Marzocchi A, Santarelli A, et al. Impact of COPD on long-term outcome after ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Chest. 2013;144:750–7.

    Article  PubMed  Google Scholar 

  16. Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol. 2007;99:636–41.

    Article  PubMed  Google Scholar 

  17. 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(9):1243–7.

    Article  PubMed  Google Scholar 

  18. Soriano JB, Rigo F, Guerrero D, et al. High prevalence of undiagnosed airflow limitation in patients with cardiovascular disease. Chest. 2010;137:333–40.

    Article  PubMed  Google Scholar 

  19. Stefan MS, Bannuru RR, Lessard D, Gore JM, Lindenauer PK, Goldberg RJ. The impact of COPD on management and outcomes of patients hospitalized with acute myocardial infarction: a 10-year retrospective observational study. Chest. 2012;141:1441–8.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Warnier MJ, Rutten FH, Numans ME, et al. Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease. COPD. 2013;10:62–71.

    Article  PubMed  Google Scholar 

  21. Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, et al. Postoperative and long-term outcome of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting. Ann Thorac Surg. 2010;89(4):1112–8.

    Article  PubMed  Google Scholar 

  22. O’Boyle F, Mediratta N, Chalmers J, et al. Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013;43(4):697–703.

    Article  PubMed  Google Scholar 

  23. Leavitt BJ, Ross CS, Spence B, et al. Long-term survival of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass surgery. Circulation. 2006;114:430–4.

    Article  Google Scholar 

  24. Saleh HZ, Mohan K, Shaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg. 2012;42:108–13.

    Article  PubMed  Google Scholar 

  25. Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can Respir J. 2007;14(1):19–24.

    PubMed Central  PubMed  Google Scholar 

  26. Wakabayashi K, Gonzalez MA, Delhaye C, et al. Impact of chronic obstructive pulmonary disease on acute-phase outcome of myocardial infarction. Am J Cardiol. 2010;106:305–9.

    Article  PubMed  Google Scholar 

  27. Anthonisen NR, Connett JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333–9.

    Article  PubMed  Google Scholar 

  28. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2(1):8–11.

    Article  PubMed  Google Scholar 

  29. Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010;137:1091–7.

    Article  PubMed  Google Scholar 

  30. Baillard C, Boussarsar M, Fosse JP, et al. Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 2003;29:584–9.

    PubMed  Google Scholar 

  31. Brekke PH, Omland T, Holmedal SH, et al. Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation. Eur Respir J. 2008;31:563–70.

    Article  CAS  PubMed  Google Scholar 

  32. Harvey MG, Hancox RJ. Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease. Emerg Med Australas. 2004;16:212–5.

    Article  PubMed  Google Scholar 

  33. Kelly AM, Klim S. Is elevated troponin associated with in-hospital mortality in emergency department patients admitted with chronic obstructive pulmonary disease? Eur J Emerg Med. 2013;20:54–7.

    Article  PubMed  Google Scholar 

  34. Marcun R, Sustic A, Brguljan PM, et al. Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease. Int J Cardiol. 2012;161:156–9.

    Article  PubMed  Google Scholar 

  35. Martins CS, Rodrigues MJ, Miranda VP, Nunes JP. Prognostic value of cardiac troponin I in patients with COPD acute exacerbation. Neth J Med. 2009;67:341–9.

    CAS  PubMed  Google Scholar 

  36. McAllister DA, Maclay JD, Mills NL, et al. Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur Respir J. 2012;39:1097–103.

    Article  CAS  PubMed  Google Scholar 

  37. Chang CL, Robinson SC, Mills GD, et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66:764–8.

    Article  PubMed  Google Scholar 

  38. Hoiseth AD, Neukamm A, Karlsson BD, et al. Elevated high sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2011;66:775–81.

    Article  CAS  PubMed  Google Scholar 

  39. Fruchter O, Yigla M. Cardiac troponin-I predicts long-term mortality in chronic obstructive pulmonary disease. COPD. 2009;6:155–61.

    Article  PubMed  Google Scholar 

  40. Campo G, Pavasini R, Malagù M, et al. Relationship between Troponin Elevation, Cardiovascular History and Cardiac Adverse Events in Patients with acute exacerbation of COPD. COPD in press.

  41. Maclay JD, MacNee W. Cardiovascular disease in COPD. Chest. 2013;143:798–807.

    Article  CAS  PubMed  Google Scholar 

  42. Hilde JM, Skjørten I, Grøtta OJ, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol. 2013;62:1103–11.

    Article  PubMed  Google Scholar 

  43. Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67.

    Article  Google Scholar 

  44. Thomson AJ, Drummond GB, Waring WS, Webb DJ, Maxwell SR. Effects of short-term isocapnic hyperoxia and hypoxia on cardiovascular function. J Appl Physiol. 2006;101:809–16.

    Article  CAS  PubMed  Google Scholar 

  45. Boschetto P, Beghé B, Fabbri LM, Ceconi C. Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice. Respirology. 2012;17(3):422–31.

    Article  PubMed  Google Scholar 

  46. Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. Coagulation factors and recurrence of ischemic and bleeding adverse events in patients with acute coronary syndromes. Thromb Res. 2013;132:151–7.

    Article  CAS  PubMed  Google Scholar 

  47. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557–65.

    Article  CAS  PubMed  Google Scholar 

  48. Wang RT, Li JY, Cao ZG, Li Y. Mean platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease. Respirology. 2013;18:1244–8.

    Article  PubMed  Google Scholar 

  49. Campo G, Fileti L, Valgimigli M, et al. Poor response to clopidogrel: current and future options for its management. J Thromb Thrombolysis. 2010;30:319–31.

    Article  CAS  PubMed  Google Scholar 

  50. Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention. Thorax. 2014;69:80–1.

    Article  PubMed  Google Scholar 

  51. Ekström MP, Hermansson AB, Ström KE. Effects of cardiovascular drugs on mortality in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187:715–20.

    Article  PubMed  Google Scholar 

  52. Harrison MT, Short P, Williamson PA, Singanayagam A, Chalmers JD, Schembri S. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease: a role for antiplatelet therapy? Thorax. 2014;69(7):609–15.

    Article  PubMed  Google Scholar 

  53. Aykan AC, Gökdeniz T, Boyacı F, et al. Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method : cardio-ankle vascular index. Herz. 2014;39:822–7.

    Article  CAS  PubMed  Google Scholar 

  54. Mills NL, Miller JJ, Anand A, et al. Increased arterial stiffness in patients with chronic obstructive pulmonary disease: a mechanism for increased cardiovascular risk. Thorax. 2008;63:306–11.

    Article  CAS  PubMed  Google Scholar 

  55. Bhatt SP, Cole AG, Wells JM, et al. Determinants of arterial stiffness in COPD. BMC Pulm Med. 2014;14:1.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Bolton CE, Stone MD, Edwards PH, Duckers JM, Evans WD, Shale DJ. Circulating matrix metalloproteinase-9 and osteoporosis in patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2009;6:81–7.

    Article  CAS  PubMed  Google Scholar 

  57. Williams MC, Murchison JT, Edwards LD, et al. Evaluation of COPD longitudinally to identify predictive surrogate endpoints (ECLIPSE) investigators. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. Thorax. 2014;69:718–23.

    Article  PubMed  Google Scholar 

  58. O’Hare PE, Ayres JF, O’Rourke RL, et al. Coronary artery calcification on computed tomography correlates with mortality in chronic obstructive pulmonary disease. J Comput Assist Tomogr. 2014;38:753–9.

    Article  PubMed  Google Scholar 

  59. Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation. 2001;104:2679–84.

    Article  CAS  PubMed  Google Scholar 

  60. Undas A, Jankowski M, Kaczmarek P, Sladek K, Brummel-Ziedins K. Thrombin generation in chronic obstructive pulmonary disease: dependence on plasma factor composition. Thromb Res. 2011;128:e24–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Karrowni W, Vyas A, Giacomino B, et al. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2013;6:814–23.

    Article  PubMed  Google Scholar 

  62. Boutou AK, Karrar S, Hopkinson NS, Polkey MI. Anemia and survival in chronic obstructive pulmonary disease: a dichotomous rather than a continuous predictor. Respiration. 2013;85:126–31.

    Article  PubMed  Google Scholar 

  63. Lahousse L, Vernooij MW, Darweesh SK, et al. Chronic obstructive pulmonary disease and cerebral microbleeds. The Rotterdam Study. Am J Respir Crit Care Med. 2013;188:783–8.

    Article  CAS  PubMed  Google Scholar 

  64. Huang KW, Luo JC, Leu HB, et al. Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study. Aliment Pharmacol Ther. 2012;35:796–802.

    Article  PubMed  Google Scholar 

  65. Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open. 2014;4:e004587–96.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Leontiadis GI, Sreedharan A, Dorward S, et al. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess. 2007;11(51):iii–iv. 1-164.

    Article  CAS  PubMed  Google Scholar 

  67. Alexopoulos D, Xanthopoulou I, Deftereos S, et al. Contraindications/Special warnings and precautions for use of contemporary oral antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Circ J. 2013;78:180–7.

    PubMed  Google Scholar 

  68. Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005;4, CD003566.

    PubMed  Google Scholar 

  69. Quint JK, Herrett E, Bhaskaran K, et al. Effect of beta-blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ. 2013;347:f6650.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  70. Young RP, Hopkins R, Eaton TE. Pharmacological actions of statins: potential utility in COPD. Eur Respir Rev. 2009;18:222–32.

    Article  CAS  PubMed  Google Scholar 

  71. Wang MT, Lo YW, Tsai CL, et al. Statin use and risk of COPD exacerbation requiring hospitalization. Am J Med. 2013;126:598–606.

    Article  CAS  PubMed  Google Scholar 

  72. Criner GJ, Connett JE, Aaron SD, et al. The COPD Clinical Research Network and the Canadian Institutes of Health Research. Simvastatin for the prevention of exacerbations in moderate-to-severe COPD. N Engl J Med. 2014;370:2201–10.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Petersen H, Sood A, Meek PM, et al. Rapid lung function decline in smokers is a risk factor for COPD and is attenuated by angiotensin-converting enzyme inhibitor use. Chest. 2014;145:695–703.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  74. Calverley PMA, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.

    Article  CAS  PubMed  Google Scholar 

  75. Hambrecht R, Walther C, Möbius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004;109:1371–8.

    Article  PubMed  Google Scholar 

  76. Carone M, Patessio A, Ambrosino N, et al. Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): the Maugeri study. Respir Med. 2007;101:2447–53.

    Article  CAS  PubMed  Google Scholar 

  77. Incorvaia C, Russo A, Foresi A, Berra D, Elia R, Passalacqua G. Effects of pulmonary rehabilitation on lung function in chronic obstructive pulmonary disease: the FIRST study. Eur J Phys Rehabil Med. 2014;50:419–26.

    CAS  PubMed  Google Scholar 

  78. Thirapatarapong W, Armstrong HF, Bartels MN. Comparison of cardiopulmonary exercise testing variables in COPD patients with and without coronary artery disease. Heart Lung. 2014;43:146–51.

    Article  PubMed  Google Scholar 

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Campo, G., Pavasini, R., Malagù, M. et al. Chronic Obstructive Pulmonary Disease and Ischemic Heart Disease Comorbidity: Overview of Mechanisms and Clinical Management. Cardiovasc Drugs Ther 29, 147–157 (2015). https://doi.org/10.1007/s10557-014-6569-y

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