Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?

Abstract

Background-Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2-to 3-fold.The factors responsible for this association remain largely unknown. Methods and Results-We analyzed data from participants, Ն50 years of age, of the Third National Health and Nutrition Examination Survey (nϭ6629) to determine whether C-reactive protein (CRP) and other systemic inflammatory markers are present in participants with chronic airflow obstruction and are associated with cardiac injury. Participants with severe airflow obstruction had circulating leukocyte, platelet, and fibrinogen levels that were 460/L (95% confidence interval [CI], 30 to 890/L), 39 510/L (95% CI, 21 730 to 57 290/L), and 41.63 mg/dL (95% CI, 19.87 to 63.39 mg/dL) higher, respectively, than in those without airflow obstruction. They were also 2.18 times (95% CI, 1.46 to 3.27) more likely to have an elevated circulating CRP level. Moderate airflow obstruction was associated with smaller but still significant increases in these levels. Moderate and severe airflow obstruction was associated with increased occurrence of ischemic changes on electrocardiograms of participants. In the presence of both highly elevated CRP and moderate or severe airflow obstruction, the Cardiac Infarction Injury Score was 2.68 and 5.88 U higher, respectively, than in those without airflow obstruction and with low CRP, which suggests an additive effect of CRP and COPD on the risk of cardiac injury. Conclusion-Low-grade systemic inflammation was present in participants with moderate to severe airflow obstruction and was associated with increased risk of cardiac injury. This may in part explain the high rates of cardiovascular complications in COPD.

Coronary artery calcification and emphysema

“…The direct relationship between chronic lung disease such as emphysema and the incidence of CVD has been known for many years (8)(9)(10)(11)(12).…”

Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

“…Also, data in a clinical population with visual scores showed that airway wall thickening is associated with future cardiovascular events [33]. Similar to CVD, COPD, emphysema and bronchiolitis are accompanied by low-grade systemic inflammation [8,11,34]. There is growing evidence indicating that cardiovascular disease is a major cause of death in COPD patients [35].…”

“…Moreover, smoking is considered the most important modifiable risk factor for developing chronic obstructive pulmonary disease (COPD) [8][9][10]. COPD is thought to be an independent risk factor for cardiovascular events [11]. The pathologic features of COPD are destruction of lung parenchyma (emphysema) and inflammation of the small airways (bronchiolitis).…”

Köpeklerde Geriatrik Kardiyoloji - Bölüm 2: Geriatrik Köpeklerde Kalp Yetmezliği Tedavisinde Zorluklar: İlaç Reaksiyonları ve Komorbitler

“…Such a hypothesis is based on the fact that patients with COPD have higher elevation of inflammatory markers [56,57] , and it fits the clinical observation of a higher incidence of troponin elevation [56] and left ventricular wall motion abnormalities [58] noted in patients with COPD and left ventricular dysfunction. Patients with HF and concomitant COPD have higher activation of neurohormones, particularly norepinephrine and plasma rennin [56] .…”