Two Distinct Chronic Obstructive Pulmonary Disease (COPD) Phenotypes Are Associated with High Risk of Mortality

Burgel, Pierre‐Régis; Paillasseur, Jean-Louis; Peene, Bernard; Dusser, Daniel; Roche, N.; Coolen, Johan; Troosters, Thierry; Decramer, Marc; Janssens, Wim

doi:10.1371/journal.pone.0051048

Cited by 111 publications

(114 citation statements)

References 21 publications

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“…The high MetS prevalence in lower disease stages coincides with the reported high cardiovascular-related mortality in mild to moderate disease (5). Furthermore, recent studies have identified a so called "co-morbidity predominant subtype" of COPD patients, which is characterized by a cluster of metabolic co-morbidities, including obesity, CVD and T2DM (43,44). This seems to coincide with the most prevalent MetS components found in our review.…”

Section: Discussionsupporting

confidence: 86%

The Prevalence of Metabolic Syndrome In Chronic Obstructive Pulmonary Disease: A Systematic Review

Lipovec

Beijers

Borst

et al. 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

140

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Type 2 Diabetes Mellitus (T2DM) and cardiovascular diseases (CVD) are common in patients with chronic obstructive pulmonary disease (COPD). Prevention of these co-morbidities in COPD requires knowledge on their risk factors. Metabolic syndrome (MetS) predisposes to the development of T2DM and CVD but its prevalence in COPD remains unclear. The aim of this review was to assess the prevalence of MetS and its components in COPD patients compared to controls and to investigate the contribution of clinical characteristics to MetS prevalence. We systematically searched PubMed and EMBASE for original studies in COPD that have investigated the prevalence of MetS and its components. In total, 19 studies involving 4208 COPD patients were included. The pooled MetS prevalence was 34%. Compared to controls, the prevalence was higher in COPD (10 studies, 32% and 30%, p = 0.001). The three most prevalent components in both COPD and controls were arterial hypertension (56% and 51%), abdominal obesity (39% and 38%) and hyperglycemia (44% and 47%). Compared to COPD patients without MetS, those with MetS had higher body mass index (BMI) (29.9 and 24.6 kg/m 2 , p < 0.001), higher forced expiratory volume in 1 second (FEV 1 ) % predicted (54 and 51, p < 0.001) and were more frequently female (31% and 25%, p = 0.011). In conclusion, the prevalence of MetS in COPD patients is high and hypertension, abdominal obesity and hyperglycemia are the most prevalent components. Further studies are needed to evaluate the impact of lifestyle factors and medications on MetS in COPD.

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Section: Discussionsupporting

confidence: 86%

The Prevalence of Metabolic Syndrome In Chronic Obstructive Pulmonary Disease: A Systematic Review

Lipovec

Beijers

Borst

et al. 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

140

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“…Furthermore, systemic disease manifestations and acute exacerbations influence disease burden and mortality risk [1]. Extending the classical descriptions of the ''pink puffer'' and ''blue bloater'', recent unbiased statistical approaches [2,3] support the concept that body weight and body composition discriminate pulmonary phenotypes, and are predictors of outcome independent of lung function impairment. Incorporation of body composition into nutritional assessment has been a major step forward in understanding systemic COPD pathophysiology and nutritional potential.…”

Section: Scopementioning

confidence: 99%

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

et al. 2014

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Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of costeffectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. @ERSpublications Metabolism and nutrition: shifting paradigms in COPD management

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“…In a cluster analysis of COPD patients age rather than disease severity accounted for most of the comorbidities [2]. One COPD phenotype is associated with cardiovascular and metabolic disease and is found in elderly patients [3]. A comprehensive analysis of comorbidities in COPD patients showed that almost all had at least one comorbidity and over 50% had four or more comorbidities [4].…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of development of multimorbidity in the elderly

2015

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In ageing populations many patients have multiple diseases characterised by acceleration of the normal ageing process. Better understanding of the signalling pathways and cellular events involved in ageing shows that these are characteristic of many chronic degenerative diseases, such as chronic obstructive pulmonary disease (COPD), chronic cardiovascular and metabolic diseases, and neurodegeneration. Common mechanisms have now been identified in these diseases, which show evidence of cellular senescence with telomere shortening, activation of PI3K-AKT-mTOR signalling, impaired autophagy, mitochondrial dysfunction, stem cell exhaustion, epigenetic changes, abnormal microRNA profiles, immunosenescence and low grade chronic inflammation ("inflammaging"). Many of these pathways are driven by chronic oxidative stress. There is also a reduction in anti-ageing molecules, such as sirtuins and Klotho, which further accelerates the ageing process. Understanding these molecular mechanisms has identified several novel therapeutic targets and several drugs have already been developed that may slow the ageing process, as well as lifestyle interventions, such as diet and physical activity. This indicates that in the future new treatment approaches may target the common pathways involved in multimorbidity and this area of research should be given high priority. Thus, COPD should be considered as a component of multimorbidity and common disease pathways, particularly accelerated ageing, should be targeted. @ERSpublications Multimorbidities share many common underlying mechanisms that may be linked to common causes such as oxidative stress

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Two Distinct Chronic Obstructive Pulmonary Disease (COPD) Phenotypes Are Associated with High Risk of Mortality

Cited by 111 publications

References 21 publications

The Prevalence of Metabolic Syndrome In Chronic Obstructive Pulmonary Disease: A Systematic Review

The Prevalence of Metabolic Syndrome In Chronic Obstructive Pulmonary Disease: A Systematic Review

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Mechanisms of development of multimorbidity in the elderly

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