Angina and chronic obstructive pulmonary disease: facing the perfect storm

Abstract

The association of chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) is challenging both in terms of prognosis and of pharmacological treatment. An 83-year-old Caucasian male patient has chronic kidney disease, COPD, previous myocardial infarction, coronary artery bypass graft with left internal mammary artery (LIMA) on left anterior descending (LAD), saphenous vein graft (SVG) on obtuse marginal (OM)1 and on right coronary artery, and percutaneous coronary intervention (PCI) on LAD (occlusion of LIMA) and on SVG for OM1 (SVG critical stenosis). Recently, the patient complained worsening angina [Canadian Cardiovascular Society (CCS) III] and had residual ischaemia in the anterior wall after an unsuccessful attempt of PCI was performed on LAD for in-stent occlusion due to restenosis. Bisoprolol uptitration failed due to worsening of pulmonary function at spirometry. For this reason, ivabradine 5 mg b.i.d. was added to bisoprolol. Afterwards, the patient referred amelioration of symptoms and he is actually in CCS Class I. The control spirometry showed moderate obstruction comparable to his chronic situation. Patients with IHD and COPD often do not receive β-blockers due to the fear of adverse effects. However, cardioselective β-blockers do not worsen pulmonary function while they reduce mortality in COPD patients. In this setting, ivabradine could be extremely helpful in order to control symptoms since it is effective in patients with asthma and COPD, with no alteration in respiratory function or symptoms and improves exercise capacity and functional class in COPD patients.

Effect of chronic lung diseases on angina pectoris among Indian adults: longitudinal ageing study in India

“…Importantly, we observed that, after adjustment to various factors, ATE value decreased from 8.4% in model 1 to 5.0% in model 2, demonstrating the observed differences in the estimates due to adjustment with lifestyle and morbidity factors. COPD and coronary artery disease are highly prevalent chronic conditions; both conditions share common risk factors 33 , 50 . COPD is characterized by progressive airflow limitation due to chronic airway inflammation 50 .…”

“…The association between COPD and Ischemic Heart Disease (IHD) exerts adverse consequences on overall prognosis. The development of both COPD and IHD is attributed to several shared factors, including exposure to inhaled noxious particles, hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, and increased arterial stiffness 33 , 34 , 34 , 35 , 35 . Notably, cardiovascular-related mortality in a significant portion of these patients follows shortly after an acute exacerbation of COPD 33 .…”

“…The development of both COPD and IHD is attributed to several shared factors, including exposure to inhaled noxious particles, hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, and increased arterial stiffness 33 , 34 , 34 , 35 , 35 . Notably, cardiovascular-related mortality in a significant portion of these patients follows shortly after an acute exacerbation of COPD 33 . Moreover, in the Towards a Revolution in COPD Health (TORCH) trial, cardiovascular deaths were observed in 26% of patients 36 .…”

AECOPD research in the past ten years: a bibliographic analysis based on Web of Science

“…It is often necessary to distinguish AECOPD from acute heart failure and coronary heart disease in clinical research. At the same time of treatment and management, it is necessary to treat both situations in many aspects, such as medication and rehabilitation (40)(41)(42).…”

Endothelial Function in Patients With Copd and Cardiovascular Disease (Review)

“…The patients with established CAD and COPD had more severe atherosclerosis vs those without COPD [55]. Another study showed that patients with COPD had more atherosclerotic lesions found in PCI compared with patients without COPD, and these patients had a higher mortality rate [56,57].…”