Link between chronic obstructive pulmonary disease and coronary artery disease: Implication for clinical practice

Abstract

Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are global epidemics that incur significant morbidity and mortality. These diseases are frequently found in combination, and they can also be found independent of the common causal factors, primarily smoking. Both conditions are systemic disorders with overlapping mechanisms and pathophysiologic processes. CAD has a strong effect on the severity and prognosis of COPD and vice versa, including acute exacerbations. Even the most recent practical clinical recommendations driven by Clinical Practice Guidelines still focus on one disease at a time, and do not provide advice for the management of patients with associated chronic conditions. COPD should be approached in a more comprehensive manner, including the treatment of cardiac comorbidities, particularly CAD. To focus treatment on these comorbidities might modify the natural course of the disease in patients with COPD who may not find relief from treatment of COPD alone.

Comorbidities of Chronic Obstructive Pulmonary Disease Patients at Respirology and Critical Care Outpatient Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

“…In addition, we could not found skeletal muscle dysfunction, osteoporosis, depression, and lung cancer as comorbidities in COPD patients. It is contrary to GOLD publication and Boschetto et al 12 study which said that besides cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome osteoporosis, depression, and lung cancer are the most common comorbidities found in COPD patients. 7 This might be happened because COPD patients that came to respirology and critical care outpatient clinic of Dr. Hasan Sadikin General Hospital did not get bone mass density (BMD) test as osteoporosis marker and mental health detection to screen depression.…”

“…Hypertension in COPD is probably due to smoking and old age as the sharing risk factor. 8,12,15 Also, hypertension could happen because of increased arterial stiffness. 15 Another study said that arterial stiffness occur frequently in COPD patients due to systemic inflammation.…”

“…7 The exact mechanism linking COPD and comorbidities is not yet known. 11 A study by Barnes 11 and Boschetto et al 12 suggested systemic inflammation as the linking mechanism. Patients with COPD have a peripheral lung inflammation which may 'spill over' to systemic circulation and cause an increase of acute-phase proteins (C-reactive protein and serum amyloid A (SAA)) and circulating cytokines (interleukin (IL)-1β, IL-6, IL-18, and tumor necrosis factor (TNF)-α).…”

Serum fetuin-A levels are associated with carotid intima–media thickness in patients with normotensive chronic obstructive pulmonary disease

“…Atherosclerosis and coronary artery disease (CAD) are some of the co-morbidities of COPD, which is considered part of a chronic systemic inflammatory syndrome. COPD is a strong risk factor for cardiovascular (CV) events and doubles the risk of CV morbidity and mortality [2,3]. There is a relationship between atherosclerosis and inflammation which plays an important role in all stages of atherosclerosis.…”

The relationship of chronic obstructive pulmonary disease and coronary heart disease: problems of pathogenesis and treatment strategy

“…Аналіз огляду досліджень вказує, що прогностична зна-чущість ХОЗЛ при несприятливих СС подіях у хворих на ІХС наближається або перевершує традиційні фактори, включаючи вік, частоту серцевих скорочень, фракції викиду лівого шлуночка, цукровий діабет, артеріальну гіпертензію та рівень креатиніну [22].…”