Should we treat chronic obstructive pulmonary disease as a cardiovascular disease?

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by largely irreversible airflow limitation and is associated with several extrapulmonary manifestations and co-morbidities. Cardiovascular diseases are among the most frequent co-morbid conditions affecting patients with COPD and have important prognostic implications for hospitalization and mortality. In turn, COPD shares common risk factors with several cardiovascular diseases (i.e., smoking habit), while several features of COPD can predispose to cardiovascular disease (i.e., gas exchange abnormalities, polycythemia, systemic inflammation and sedentary lifestyle). Cardiovascular co-morbidities in patients with COPD are under-recognized and undertreated and should be actively sought and treated according to usual guidelines. This review will discuss the increased prevalence and prognostic implications of cardiovascular co-morbidities in patients with COPD. The effect of COPD on the outcomes in cardiovascular disease will also be highlighted and the pathogenic mechanisms that underlie cardiovascular co-morbidities in patients with COPD will also be reviewed. Finally, options for the management of cardiovascular co-morbidities in patients with COPD will be discussed.

Keywords:

• cardiovascular disease
• chronic obstructive pulmonary disease
• co-morbidities
• morbidity
• mortality

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Cardiovascular co-morbidities are highly prevalent in patients with chronic obstructive pulmonary disease (COPD).

• COPD is a well-known risk factor for the development of cardiovascular disease.

• Cardiovascular complications are a major contributor to morbidity and mortality in COPD.

• COPD has negative prognostic implications in patients with cardiovascular disease.

• Cardiovascular co-morbidities are under-diagnosed in patients with COPD.

• COPD and cardiovascular disease share common risk factors.

• Several features of COPD are associated with increased cardiovascular risk.

• Cardiovascular co-morbidities should be actively sought and treated in COPD according to usual guidelines.

• Management of COPD should be moving from a reductionist approach to an integrated approach to define, identify and treat the multiple organ involvement of this complex syndrome.

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