Angiotensin-Converting Inhibitors and Angiotensin II Receptor Blockers and Longitudinal Change in Percent Emphysema on Computed Tomography. The Multi-Ethnic Study of Atherosclerosis Lung Study

Parikh, Megha; Aaron, Carrie P.; Hoffman, Eric A.; Schwartz, Joseph E.; Madrigano, Jaime; Austin, John; Kalhan, Ravi; Lovasi, Gina S.; Watson, Karol E.; Stukovsky, Karen Hinckley; Barr, R. Graham

doi:10.1513/annalsats.201604-317oc

Cited by 47 publications

(34 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our recommendations CV diseases are often underdiagnosed and under-treated in patients with COPD [18]. Furthermore, treatment with therapies targeted to treat comorbidities such as HF, IHD, AF and hypertension have the potential to modify the natural history of patients with COPD [115,124]. We therefore support the active detection and management of comorbidities in COPD and suggest using relevant treatment guidelines for patients without COPD in the absence of more specific information.…”

Section: Managementmentioning

confidence: 74%

“…Data on the effects of RAAS inhibitors in patients with COPD are limited, although a couple of small studies have indicated a potential benefit on pulmonary function and haemodynamics [105,106]. More recently, an analysis of the Multi Ethnic Study of Atherosclerosis (MESA), including individuals in the general population aged 45-84 years who had no clinical evidence of CV disease, found that baseline use of an ACEI or ARB protected against the progression of emphysema, especially when prescribed at high doses [124]. The authors attributed the effects of such RAAS inhibitors to inhibition of transforming growth factor-β signalling in the lung, thereby reducing the progression of airspace enlargement.…”

Section: Renin-angiotensin-aldosterone System Inhibitors Aceis and Arbsmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular disease and COPD: dangerous liaisons?

2018

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. Pathophysiological links between COPD and CVD include lung hyperinflation, systemic inflammation and COPD exacerbations. COPD treatments may produce beneficial cardiovascular (CV) effects, such as long-acting bronchodilators, which are associated with improvements in arterial stiffness, pulmonary vasoconstriction, and cardiac function. However, data are limited regarding whether these translate into benefits in CV outcomes. Some studies have suggested that treatment with long-acting β2-agonists and long-acting muscarinic antagonists leads to an increase in the risk of CV events, particularly at treatment initiation, although the safety profile of these agents with prolonged use appears reassuring. Some CV medications may have a beneficial impact on COPD outcomes, but there have been concerns about β-blocker use leading to bronchospasm in COPD, which may result in patients not receiving guideline-recommended treatment. However, there are few data suggesting harm with these agents and patients should not be denied β-blockers if required. Clearer recommendations are necessary regarding the identification and management of comorbid CVD in patients with COPD in order to facilitate early intervention and appropriate treatment.

show abstract

Section: Managementmentioning

confidence: 74%

Section: Renin-angiotensin-aldosterone System Inhibitors Aceis and Arbsmentioning

confidence: 99%

Cardiovascular disease and COPD: dangerous liaisons?

2018

View full text Add to dashboard Cite

show abstract

“…Angiotensin inhibition. As hypertension is a common COPD comorbidity, angiotensin‐converting enzyme inhibitors may have a dual purpose in COPD and CVD as they appear to protect against declines in lung function, particularly in individuals with CVD . Although retrospective studies demonstrate an association between angiotensin blockade and reduced mortality, large prospective studies are lacking.…”

Section: Managementmentioning

confidence: 99%

Coexisting chronic obstructive pulmonary disease and cardiovascular disease in clinical practice: a diagnostic and therapeutic challenge

Leong

MacDonald

et al. 2019

Medical Journal of Australia

View full text Add to dashboard Cite

C hronic obstructive pulmonary disease (COPD) is the cardinal smoking-related respiratory illness. 1,2 Diagnosis requires exposure to noxious inhalants, respiratory symptoms, and spirometry demonstrating airflow obstruction, defined by a post-bronchodilator forced expiratory volume in one second (FEV 1 ) divided by forced vital capacity ratio < 0.70. 1,2 COPD is the fifth leading cause of disability-adjusted life-years worldwide, affecting about 14% of Australians above the age of 40 years. 2 COPD has a profound impact on the Australian hospital system. In 2015-16, it was the most common cause of potentially preventable hospitalisations related to chronic conditions in Australia; it was followed by heart failure. 3 In Australian general practice, both respiratory presentations and cardiovascular issues are common, so co-occurrence is frequent. 4 Cardiovascular disease (CVD) has compelling links to COPD. Individuals with COPD have a nearly 2.5-fold risk of CVD in comparison with controls. 5 Moreover, patients with comorbid COPD and CVD report more breathlessness and worse quality of life, are more frequently hospitalised and have higher mortality than those with COPD alone. 6 More than a quarter of patients with COPD will die from a cardiovascular event, and 40% of patients with COPD and a cardiovascular history will die following a cardiovascular event. 6Despite this, under-diagnosis of CVD in patients with COPD is frequent. For example, in patients with COPD and electrocardiographic evidence of myocardial infarction, less than one-third had been diagnosed with CVD. 7 COPD and CVD share risk factors and symptoms with significant overlap in clinical presentations. Determining the presence and contributions of the individual diseases can help clinicians prognosticate and manage this complex population.We searched PubMed for COPD and cardiovascular terms. We examined clinically relevant aspects of their relationship, diagnostic challenges and current and future therapeutic strategies. COPD and CVD: shared pathophysiologyDisease processes in COPD and CVD overlap, and salient clinical aspects are outlined below. Shared risk factorsPatients with COPD generally have multiple major risk factors for CVD. They have almost invariably smoked, and tend to be older, male and less physically active (Box 1). Hypertension is highly prevalent and present in up to 77% of some COPD cohorts. 1,5 However, these are insufficient to explain the excess CVD prevalence seen in COPD. 6 1

show abstract

“…A recent study evaluated 4,472 participants and showed that A2RB and ACEI were associated with a slow progression of CTE 6 . However, this finding merits to be confirmed in randomized clinical trials including patients with CTE and normal FEV 1 /FVC ratio, especially considering that, to date, there is no treatment recommended for these people 2 …”

mentioning

confidence: 99%

“…, 6 Therefore, we have to pay attention to patients with CT emphysema (CTE) before they present with an altered FEV 1 /FVC ratio. However, how can we prevent the progression of CTE to GOLD-defined COPD?…”

mentioning

confidence: 99%

A murine model of elastase- and cigarette smoke-induced emphysema: is it an opportunity to understand CT emphysema in humans?

Santana

2017

J. bras. pneumol.

View full text Add to dashboard Cite

COPD is an important public health care problem, being the third leading cause of death in the United States. In addition, researchers say that the prevalence of COPD will rise over the next decades. This fact is explained by the increase in smoking in developing countries and by worldwide aging, considering that COPD is up to three times more prevalent in elderly people (> 60 years of age) than in younger people. Consequently, COPD has been related to accelerated lung aging, including cell senescence and antiaging molecules. Therefore, knowing COPD-related changes that come with aging might help to discover novel therapies against this important disease.( 1) Classically, COPD is defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a disease that causes respiratory symptoms and persistent airflow limitation. This airflow limitation is shown by spirometry with reduced FEV 1 /FVC ratio (post-bronchodilator FEV 1 / FVC < 0.70).(2) However, it has been recently demonstrated that smokers with preserved FEV 1 /FVC ratio may already present with respiratory symptoms, respiratory exacerbations, limitation of activities, emphysema, and airway wall thickening on chest CT. (3)(4)(5) In special, people with emphysema on chest CT and preserved FEV 1 /FVC ratio present with lower DLCO, altered quality of life, more frequent respiratory exacerbations, and even increased mortality.(3,6) Therefore, we have to pay attention to patients with CT emphysema (CTE) before they present with an altered FEV 1 /FVC ratio. However, how can we prevent the progression of CTE to GOLD-defined COPD?One possibility is to use angiotensin II receptor blockers (A2RB) or angiotensin converting enzyme inhibitors (ACEI). A recent study evaluated 4,472 participants and showed that A2RB and ACEI were associated with a slow progression of CTE.(6) However, this finding merits to be confirmed in randomized clinical trials including patients with CTE and normal FEV 1 /FVC ratio, especially considering that, to date, there is no treatment recommended for these people.

show abstract

Angiotensin-Converting Inhibitors and Angiotensin II Receptor Blockers and Longitudinal Change in Percent Emphysema on Computed Tomography. The Multi-Ethnic Study of Atherosclerosis Lung Study

Abstract: In a large population-based study, ACE inhibitors and ARBs were associated with slowed progression of percent emphysema by chest CT, particularly among former smokers. Randomized clinical trials of ACE and ARB agents are warranted for the prevention and treatment of emphysema.

Cited by 47 publications

References 57 publications

Cardiovascular disease and COPD: dangerous liaisons?

Cardiovascular disease and COPD: dangerous liaisons?

Coexisting chronic obstructive pulmonary disease and cardiovascular disease in clinical practice: a diagnostic and therapeutic challenge

A murine model of elastase- and cigarette smoke-induced emphysema: is it an opportunity to understand CT emphysema in humans?

Contact Info

Product

Resources

About