Cardiovascular disease and risk in COPD: a state of the art review

Figures & data

Figure 1. Mechanism of cardiovascular risk in COPD.

Cardiovascular disease and COPD share common risk factors, such as smoking and putatively shared pathways such as accelerated aging and the risk of COPD and CVD in individuals with a low lung function trajectory during childhood. Once COPD has been established, the risk of CVD is increased through the effects of systemic inflammation, hypoxemia and hyperinflation on the heart, vasculature, and autonomic nerve system. These combined effects lead to impaired cardiac function, endothelial dysfunction, and autonomic nerve disbalance, which predisposes these individuals living with COPD to the development of cardiovascular events such as myocardial infarction, heart failure, stroke and arrhythmias. The pathophysiology of COPD also increases the risk of developing other cardiovascular risk factors such as hypertension, diabetes mellitus and sleep apnea which further augments the development of such cardiovascular events. Created with BioRender.com.

Figure 2. Cardiovascular risk assessment in COPD.

Proposed algorithm for the assessment and treatment of cardiovascular risk in people living with COPD. This includes the recognition of shared risk factors, case finding for underlying cardiovascular disease, and the identification of COPD-related factors associated with the increased risk of cardiovascular disease such as recurrent exacerbation. Additional studies should include the use of formal risk assessment tools, blood measurements, lung function, ECG and CT thorax. If indicated, screening for pulmonary hypertension and sleep apnea should follow. Treatment of cardiovascular risk is based on three pillars, namely addressing risk factors with (non)-pharmacological interventions, guideline-based treatment of cardiovascular disease and optimizing COPD treatment.

Abbreviations: ABG, arterial blood gas; AF, atrial fibrillation; BNP, brain natriuretic peptide; COPD; chronic obstructive pulmonary disease; ECG, electrocardiogram; ICS, inhalation corticosteroid; LABA, long-acting beta-2-agonist; LAMA, long-acting muscarinic antagonist; OSA, obstructive sleep apnea; PPG, photoplethysmography.