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Kibbler J, Wade C, Mussell G, Ripley DP, Bourke SC, Steer J. Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD. ERJ Open Res 2023; 9:00548-2023. [PMID: 38020568 PMCID: PMC10680032 DOI: 10.1183/23120541.00548-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. Methods A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. Results In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Conclusion Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.
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Affiliation(s)
- Joseph Kibbler
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Clare Wade
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Grace Mussell
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - David P. Ripley
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - Stephen C. Bourke
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Steer
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
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2
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Ferreira EJP, Cardoso LVSDC, de Matos CJO, Mota IL, Lira JMC, Lopes MEG, Santos GV, Dória Almeida ML, Aguiar-Oliveira MH, Sousa ACS, de Melo EV, Oliveira JLM. Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1899-1908. [PMID: 37662489 PMCID: PMC10474840 DOI: 10.2147/copd.s410416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/06/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.
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Affiliation(s)
- Eduardo José Pereira Ferreira
- Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Lucas Villar Shan de Carvalho Cardoso
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | | | - Igor Larchert Mota
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Juliana Maria Chianca Lira
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Mayara Evelyn Gomes Lopes
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Giulia Vieira Santos
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Maria Luiza Dória Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Manuel Herminio Aguiar-Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Enaldo Vieira de Melo
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Joselina Luzia Menezes Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
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3
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Hagmann M, Baty F, Rassouli F, Maeder MT, Brutsche MH. Gender-specific disease trajectories prior to the onset of COPD allow individualized screening and early intervention. PLoS One 2023; 18:e0288237. [PMID: 37418429 DOI: 10.1371/journal.pone.0288237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Nation-wide hospitalization databases include diagnostic information at the level of an entire population over an extended period of time. Comorbidity network and early disease development can be unveiled. Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition for which it is crucial to identify early disease indicators. The identification of gender-specific conditions preceding the onset of COPD may reveal disease progression patterns allowing for early diagnosis and intervention. The objective of the study was to investigate the antecedent hospitalization history of patients newly diagnosed with COPD and to retrace a gender-specific trajectory of coded entities prior to the onset of COPD. MATERIAL AND METHODS A population-wide hospitalization database including information about all hospitalizations in Switzerland between 2002 and 2018 was used. COPD cases were extracted from the database and comorbidities occurring prior to the onset of COPD identified. Comorbidities significantly over-represented in COPD compared with a 1:1, age- and sex-matched control population were identified and their longitudinal evolution was analyzed. RESULTS Between 2002 and 2018, 697,714 hospitalizations with coded COPD were recorded in Switzerland. Sixty-two diagnoses were significantly over-represented before onset of COPD. These preceding comorbidities included both well-established conditions and novel links to COPD. Early pre-conditions included nicotine and alcohol abuse, obesity and cardiovascular diseases. Later comorbidities included atrial fibrillation, diseases of the genitourinary system and pneumonia. Atherosclerotic heart diseases were more prevalent in males, whereas hypothyroidism, varicose and intestinal disorders were more frequent in females. Disease trajectories were validated using an independent data set. CONCLUSIONS Gender-specific disease trajectories highlight early indicators and pathogenetic links between COPD and antecedent diseases and could allow for early detection and intervention.
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Affiliation(s)
- Michelle Hagmann
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Micha T Maeder
- Department of Cardiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Alachkar MN, Müller T, Alnaimi A, Milzi A, Kneizeh K, Altiok E, Schröder J, Reith S, Marx N, Dreher M, Almalla M, Daher A. Safety and efficacy of transcatheter mitral valve repair in patients with COPD; results from real-world cohort. Catheter Cardiovasc Interv 2022; 100:145-153. [PMID: 35615874 DOI: 10.1002/ccd.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of transcatheter mitral valve repair (TMVR) in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND Heart failure and COPD share many clinical features and commonly coexist. Data about the safety and efficacy of TMVR in patients with COPD is not conclusive. METHODS Three hundred and forty consecutive patients undergoing TMVR were retrospectively included. COPD diagnosis was based on pulmonary function tests (PFTs). Intra-hospital, 30-day- and 1-year outcomes were compared between both groups. RESULTS Eighty-two patients had COPD (24%). There was no difference in intra-hospital mortality between patients with and without COPD (both 5%, p = 0.95). Among patients who had a successful procedure and survived to discharge there was a trend toward more rehospitalization due to decompensated heart failure at 30-day follow-up in patients with COPD (12.9% vs. 6.8%, p = 0.08) with no difference in mortality. At median follow-up of 1 year, New York heart association (NYHA) category was comparable among both groups and there was no significant difference in rehospitalization (COPD: 29.9% vs. non-COPD: 34%, p = 0.5). There was a trend toward increased 1-year mortality in COPD patients (31.2% vs. 20.6%, p = 0.06). However, a composite endpoint of rehospitalization or death at 1 year did not differ between both groups (48% vs. 42.5%, p = 0.4). Regression analysis showed no correlation between COPD severity and worse TMVR outcomes. CONCLUSIONS COPD is highly prevalent among patients undergoing TMVR. However, TMVR seems to be safe and effective in COPD patients. COPD severity and PFT impairment alone should not be considered as a contraindication for TMVR.
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Affiliation(s)
- Mhd Nawar Alachkar
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Tobias Müller
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Anas Alnaimi
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Andrea Milzi
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Kinan Kneizeh
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Sebastian Reith
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany.,Clinic for Cardiology and Angiology, St. Franziskus-Hospital, Münster, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Ayham Daher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
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5
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Grebe J, Müller T, Altiok E, Becker M, Keszei AP, Marx N, Dreher M, Daher A. Effects of COPD on Left Ventricular and Left Atrial Deformation in Patients with Acute Myocardial Infarction: Strain Analysis Using Speckle-Tracking Echocardiography. J Clin Med 2022; 11:jcm11071917. [PMID: 35407524 PMCID: PMC8999583 DOI: 10.3390/jcm11071917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Myocardial strain analysis, which describes myocardial deformation (shortening or lengthening), provides more detailed information about left ventricular (LV) and atrial (LA) functions than conventional echocardiography and delivers prognostic information. To analyze the effects of COPD on left heart function upon acute myocardial infarction (AMI), consecutive AMI patients were retrospectively screened, and patients were included if a post-AMI echocardiography and results of recent pulmonary function tests (PFTs) were available. Strain analysis was performed by a cardiologist who was blinded to clinical information. Overall, 109 AMI patients were included (STEMI: 38%, non-STEMI: 62%). COPD patients (41%) had significantly more impaired LV “global-longitudinal-strain” (LV-GLS) compared to non-COPD patients (−15 ± 4% vs. −18 ± 4%; p < 0.001, respectively), even after adjusting for LV-ejection-fraction (LVEF) and age (mean estimated difference: 1.7%, p = 0.009). Furthermore, COPD patients had more impaired LA strain (LAS) than non-COPD patients in all cardiac cycle phases (estimated mean differences after adjusting for LVEF and age: during reservoir phase: −7.5% (p < 0.001); conduit phase: 5.5% (p < 0.001); contraction phase: 1.9% (p = 0.034)). There were no correlations between PFT variables and strain values. In conclusion, the presence of COPD was associated with more impaired LV and LA functions after AMI, as detected by strain analysis, which was independent of age, LVEF, and PFT variables.
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Affiliation(s)
- Julian Grebe
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Tobias Müller
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Michael Becker
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
- Department of Cardiology, Nephrology and Intensive Care Medicine, Rhein-Maas Hospital, 52146 Wuerselen, Germany
| | - András P. Keszei
- Center for Translational & Clinical Research Aachen (CTC-A), University Hospital RWTH, 52074 Aachen, Germany;
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (J.G.); (E.A.); (M.B.); (N.M.)
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
| | - Ayham Daher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany; (T.M.); (M.D.)
- Correspondence:
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6
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Spilling CA, Dhillon MPK, Burrage DR, Ruickbie S, Baker EH, Barrick TR, Jones PW. Factors affecting brain structure in smoking-related diseases: Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease. PLoS One 2021; 16:e0259375. [PMID: 34739504 PMCID: PMC8570465 DOI: 10.1371/journal.pone.0259375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Changes in brain structure and cognitive decline occur in Chronic Obstructive Pulmonary Disease (COPD). They also occur with smoking and coronary artery disease (CAD), but it is unclear whether a common mechanism is responsible. Methods Brain MRI markers of brain structure were tested for association with disease markers in other organs. Where possible, principal component analysis (PCA) was used to group markers within organ systems into composite markers. Univariate relationships between brain structure and the disease markers were explored using hierarchical regression and then entered into multivariable regression models. Results 100 participants were studied (53 COPD, 47 CAD). PCA identified two brain components: brain tissue volumes and white matter microstructure, and six components from other organ systems: respiratory function, plasma lipids, blood pressure, glucose dysregulation, retinal vessel calibre and retinal vessel tortuosity. Several markers could not be grouped into components and were analysed as single variables, these included brain white matter hyperintense lesion (WMH) volume. Multivariable regression models showed that less well organised white matter microstructure was associated with lower respiratory function (p = 0.028); WMH volume was associated with higher blood pressure (p = 0.036) and higher C-Reactive Protein (p = 0.011) and lower brain tissue volume was associated with lower cerebral blood flow (p<0.001) and higher blood pressure (p = 0.001). Smoking history was not an independent correlate of any brain marker. Conclusions Measures of brain structure were associated with a range of markers of disease, some of which appeared to be common to both COPD and CAD. No single common pathway was identified, but the findings suggest that brain changes associated with smoking-related diseases may be due to vascular, respiratory, and inflammatory changes.
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Affiliation(s)
- Catherine A Spilling
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Mohani-Preet K Dhillon
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Daniel R Burrage
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Sachelle Ruickbie
- Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emma H Baker
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Paul W Jones
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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7
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Martinez-Garcia MÁ, Faner R, Oscullo G, la Rosa-Carrillo D, Soler-Cataluña JJ, Ballester M, Muriel A, Agusti A. Chronic bronchial infection and incident cardiovascular events in chronic obstructive pulmonary disease patients: A long-term observational study. Respirology 2021; 26:776-785. [PMID: 34002922 DOI: 10.1111/resp.14086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/27/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular (CV) diseases are frequent in patients with chronic obstructive pulmonary disease (COPD). Likewise, chronic bronchial infection (CBI) is also frequent in COPD and it is associated with systemic inflammation, a well-known CV risk factor. The objective of this study was to investigate the relationship between CBI, systemic inflammation and incident CV events. METHODS A post hoc analysis of prospectively collected cohort of 201 COPD patients [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II-IV] followed up every 3-6 months for 84 months was conducted. CBI was defined as ≥3 positive pathogenic microorganisms sputum cultures over 1 year, separated by ≥3 months. Systemic inflammation was assessed by circulating levels of C-reactive protein and fibrinogen. Fatal and non-fatal CV events, including coronary and cerebrovascular events as well as arrhythmia episodes, were prospectively recorded. For analysis, they were analysed separately and combined in a composite variable. RESULTS As hypothesized, CBI was associated with persistent systemic inflammation and a significantly higher incidence of CV events (HR: 3.88; 95% CI: 1.83-8.22), mainly of coronary origin independent of age, number and severity of exacerbations, comorbidities, other CV risk factors, lung function, BMI, smoking status and treatments. These associations were particularly significant in patients with CBI by Pseudomonas aeruginosa (PA). CONCLUSION CBI, particularly by PA, is associated with sustained and enhanced systemic inflammation and a higher incidence of CV events (especially coronary events). The possibility that treating CBI may decrease systemic inflammation and CV events in COPD deserves prospective, interventional studies.
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Affiliation(s)
- Miguel Ángel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Faner
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Institut d'investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Grace Oscullo
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Marta Ballester
- Pneumology Unit, Hospital General de Requena, Valencia, Spain
| | - Alfonso Muriel
- Biostatistic Unit, Hospital Ramón y Cajal, IRYCIS, CIBERESP and Universidad de Alcalá, Madrid, Spain
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Institut d'investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Respiratory Institute, Hospital Clinic University, Barcelona, Spain
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