High risk of subclinical atherosclerosis in COPD exacerbator phenotype

Domenech, Adolfo; Muñoz-Montiel, Ana; García‐Casares, Natalia; Rioja, José; Ruiz-Esteban, Pedro; Castaño, Patricia Gutiérrez; Pardell, María Jesús Prunera; Olveira, Casilda; Valdivielso, Pedro; Sánchez-Chaparro, Miguel Ángel

doi:10.1016/j.rmed.2018.07.004

Cited by 10 publications

(4 citation statements)

References 41 publications

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“…In patients with COPD, asymptomatic CVD progression significantly heightens the risk of comorbid CVD-associated mortality, and this is largely due to these patients being at heightened risk of atherosclerosis, due to the persistent systemic inflammation associated with this disease. Atherosclerosis is defined as a condition that causes the innermost layer of a blood vessel (endothelial layer), to become narrowed and hardened due to a build-up of fatty tissue and subsequent plaque formation, possibly leading to cardiovascular complications such as vascular occlusions and ischaemic stroke [85]. Key risk factors of atherosclerosis include cigarette smoking, elevated BP and high cholesterol associated with poor lifestyle (e.g.…”

Section: Atherosclerosis and Impaired Blood Vessel Function In Copdmentioning

confidence: 99%

New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease

et al. 2019

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Chronic obstructive pulmonary disease (COPD) is a disease characterised by persistent airflow limitation that is not fully reversible and is currently the fourth leading cause of death globally. It is now well established that cardiovascular-related comorbidities contribute to morbidity and mortality in COPD, with approximately 50% of deaths in COPD patients attributed to a cardiovascular event (e.g. myocardial infarction). Cardiovascular disease (CVD) and COPD share various risk factors including hypertension, sedentarism, smoking and poor diet but the underlying mechanisms have not been fully established. However, there is emerging and compelling experimental and clinical evidence to show that increased oxidative stress causes pulmonary inflammation and that the spill over of pro-inflammatory mediators from the lungs into the systemic circulation drives a persistent systemic inflammatory response that alters blood vessel structure, through vascular remodelling and arterial stiffness resulting in atherosclerosis. In addition, regulation of endothelial-derived vasoactive substances (e.g. nitric oxide (NO)), which control blood vessel tone are altered by oxidative damage of vascular endothelial cells, thus promoting vascular dysfunction, a key driver of CVD. In this review, the detrimental role of oxidative stress in COPD and comorbid CVD are discussed and we propose that targeting oxidant-dependent mechanisms represents a novel strategy in the treatment of COPD-associated CVD.

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Section: Atherosclerosis and Impaired Blood Vessel Function In Copdmentioning

confidence: 99%

New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease

et al. 2019

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“…The prevalence of CVD was significantly higher in participants with PRISm results and GOLD stage II COPD, leading them to conclude that people with poor spirometry, especially those with moderate COPD and patients with PRISm, have a higher incidence of CVD compared to those with normal spirometry, such that having COPD increases the risk of developing CVD 42 . A previous study by our group analysed CVR in the total sample of COPD patients and found elevated values in all the scales used, both in exacerbator and non-exacerbator patients, but there were no significant differences according to clinical phenotypes 43 .…”

Section: Discussionmentioning

confidence: 78%

Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype

Montiel,

Ruiz-Esteban,

Del Río

et al. 2024

Sci Rep

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Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.

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“…Subclinical atherosclerosis of the carotid arteries is more pronounced in patients with COPD exacerbation. Patients with COPD exacerbations have a higher risk of vascular ischemic events [45]. A large study conducted in the United States found that COPD exacerbations were associated with an increased incidence of acute cardiovascular events within 30 days and one year [46].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Comorbid Course of Chronic Obstructive Pulmonary Disease

Kotlyarov

2023

JPM

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(1) Background. Chronic obstructive pulmonary disease (COPD) has a heterogeneous natural history, manifested both in the variability of clinical features and in association with various comorbid pathologies. Atherosclerotic cardiovascular disease (ASCVD) is of great clinical importance and contributes significantly to the natural history and prognosis of COPD. The present study aimed to evaluate the nature of the comorbid course of COPD during a 15-year follow-up. (2) Methods: A total of 170 male COPD patients were included in this study. Spirometry values, symptom severity, presence of risk factors, and comorbidities were considered. Prognostic factors were evaluated using the Kaplan–Meier method. (3) Results: ASCVD was the most common comorbidity and the main cause of death in patients with COPD. Patients with comorbid COPD and ASCVD had more severe dyspnea, higher frequency of COPD exacerbations, and worse survival than patients without ASCVD (p < 0.01). Among patients with COPD, the risk of death from ASCVD was higher in those older than 60 years (OR 3.23, 95% CI [1.72, 6.07]), those with rapidly declining FEV1 (OR 4.35, 95% CI [2.28, 8.30]), those with more than two exacerbations per year (OR 3.21, 95% CI [1.71, 6.11]), and those with a pack year index greater than 30 (OR 2.75, 95% CI [1.38, 5.51]. High Charlson comorbidity index scores in patients with COPD were associated with a more severe disease course, including severity of dyspnea, frequency of exacerbations, and multivariate index scores. A high Charlson comorbidity index score was an adverse prognostic factor. (4) Conclusions: ASCVD influences the course of the disease and is a major cause of mortality in COPD patients.

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High risk of subclinical atherosclerosis in COPD exacerbator phenotype

Cited by 10 publications

References 41 publications

New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease

New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease

Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype

Analysis of the Comorbid Course of Chronic Obstructive Pulmonary Disease

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