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

ABSTRACT

Introduction

Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited.

Areas Covered

1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD.

Expert Opinion

The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006–2023.

KEYWORDS:

• COPD
• cardiovascular disease
• cardiovascular risk
• exacerbations
• therapeutics
• arrhythmia

Article highlights

• The new definition and classification of Chronic Obstructive Pulmonary Disease (COPD) and the term Preserved Ratio Impaired Spirometry (PRISm) to identify individuals with an increased risk for cardiovascular disease (CVD).

• The high disease burden of co-morbid COPD and CVD and importance of recognizing and treating both COPD and cardiovascular disease in people living with both conditions.

• Mechanisms underlying the increased prevalence of CVD in COPD, such as shared risk factors, systemic inflammation, accelerated aging, impaired lung function trajectories, hypoxemia and hyperinflation

• The challenges of diagnosing COPD in people with cardiovascular disease using questionnaires and pulmonary function tests.

• The pivotal role of exacerbations of COPD in the increased risk of CVD

• Potential therapies that decrease the cardiovascular risk in people with COPD including combined (‘triple’) inhaler drugs

• A pro-active identification of CVD risk in COPD and propose a treatment strategy to mitigate this increased cardiovascular risk

• The challenges of implementing cardiovascular risk reduction in a population with COPD and put forward a research agenda of unresolved questions that should be addressed in future studies

Declaration of interests

S.O. Simons has received grants from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Roche; Consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi and GlaxoSmithKline; payment or honoraria for lectures and presentations from AstraZeneca and Chiesi; Support for attending meetings and/or travel from AstraZeneca and Chiesi; leadership role as chair to Dutch COPD working group of the Dutch Thoracic Society; Oximeters from the Dutch Thoracic Society. All payments were to his institution. J.R. Hurst has received grants from AstraZeneca; consulting fees from AstraZeneca and GlaxoSmithKline; payment or honoraria for presentations and lectures from AstraZeneca, Boehringer Ingelheim, Chiesi, Sanofi and Takeda; support for attending meeting and/or travel from AstraZeneca; participation in advisory board from AstraZeneca: Donation of Nonin oximeters. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.