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Arif W, Bhimani RK, Ali Shah M, Tausif Z, Nisar U, Kumar R, Bhimani PD, Shoaibullah S, Naveed MA, Raja A, Raja S, Deepak F, Shafique MA, Mustafa MS. Unraveling disparities: Probing gender, race, and geographic inequities in pulmonary heart disease mortality in the United States: An extensive longitudinal examination (1999-2020) leveraging CDC WONDER data. Curr Probl Cardiol 2024; 49:102527. [PMID: 38492618 DOI: 10.1016/j.cpcardiol.2024.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
This comprehensive study delves into the epidemiological landscape of Pulmonary Heart Disease (PHD) mortality in the United States from 1999 to 2020, leveraging the extensive CDC WONDER database. PHD encompasses conditions affecting the right side of the heart due to lung disorders or elevated pressure in the pulmonary arteries, including pulmonary hypertension, pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH). Analyzing data from death certificates, demographic characteristics, and geographical segmentation, significant trends emerge. The age-adjusted mortality rates (AAMRs) for PHD-related deaths show a fluctuating pattern, initially decreasing from 1999 to 2006, followed by a steady increase until 2020. Male patients consistently exhibit higher AAMRs than females, with notable disparities observed among racial/ethnic groups and geographic regions. Non-hispanic (NH) Black or African American individuals, residents of specific states like Colorado and the District of Columbia, and those in the Midwest region demonstrate elevated AAMRs. Furthermore, nonmetropolitan areas consistently manifest higher AAMRs than metropolitan areas. These findings underscore the urgent need for intensified prevention and treatment strategies to address the rising mortality associated with PHD, particularly among vulnerable populations. Insights from this study offer valuable guidance for public health initiatives aimed at reducing PHD-related mortality and improving outcomes nationwide.
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Affiliation(s)
- Waqar Arif
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohsin Ali Shah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Umer Nisar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohet Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Syed Shoaibullah
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Adarsh Raja
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Sandesh Raja
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fnu Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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Zhou L, Jian T, Wan Y, Huang R, Fang H, Wang Y, Liang C, Ding X, Chen J. Luteolin Alleviates Oxidative Stress in Chronic Obstructive Pulmonary Disease Induced by Cigarette Smoke via Modulation of the TRPV1 and CYP2A13/NRF2 Signaling Pathways. Int J Mol Sci 2023; 25:369. [PMID: 38203542 PMCID: PMC10779282 DOI: 10.3390/ijms25010369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The current study aims to investigate the therapeutic potential of luteolin (Lut), a naturally occurring flavonoid found in various medicinal plants, for treating chronic obstructive pulmonary disease (COPD) through both in vitro and in vivo studies. The results demonstrated that Lut increased body weight, reduced lung tissue swelling and lung damage indices, mitigated systemic oxidative stress levels, and decreased alveolar fusion in cigarette smoke (CS)- and lipopolysaccharide (LPS)-induced COPD mice. Additionally, Lut was observed to downregulate the expression of the TRPV1 and CYP2A13 proteins while upregulating SIRT6 and NRF2 protein expression in CS + LPS-induced COPD mice and cigarette smoke extract (CSE)-treated A549 cells. The concentrations of total reactive oxygen species (ROS) and mitochondrial ROS in A549 cells induced by CSE significantly increased. Moreover, CSE caused a notable elevation of intracellular Ca2+ levels in A549 cells. Importantly, Lut exhibited inhibitory effects on the inward flow of Ca2+ and attenuated the overproduction of mitochondrial and intracellular ROS in A549 cells treated with CSE. In conclusion, Lut demonstrated a protective role in alleviating oxidative stress and inflammation in CS + LPS-induced COPD mice and CSE-treated A549 cells by regulating TRPV1/SIRT6 and CYP2A13/NRF2 signaling pathways.
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Affiliation(s)
- Lina Zhou
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China; (L.Z.); (T.J.); (C.L.)
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
| | - Tunyu Jian
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China; (L.Z.); (T.J.); (C.L.)
| | - Yan Wan
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
| | - Rizhong Huang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
| | - Hailing Fang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
| | - Yiwei Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
| | - Chengyuan Liang
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China; (L.Z.); (T.J.); (C.L.)
| | - Xiaoqin Ding
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China; (L.Z.); (T.J.); (C.L.)
| | - Jian Chen
- Jiangsu Key Laboratory for the Research and Utilization of Plant Resources, Institute of Botany, Jiangsu Province and Chinese Academy of Sciences, Nanjing 210014, China; (L.Z.); (T.J.); (C.L.)
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; (Y.W.); (R.H.); (H.F.); (Y.W.)
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Liu D, Cheng K, Huang K, Ding H, Xu T, Chen Z, Sun Y. Visualization and Analysis of Air Pollution and Human Health Based on Cluster Analysis: A Bibliometric Review from 2001 to 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12723. [PMID: 36232020 PMCID: PMC9566718 DOI: 10.3390/ijerph191912723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Bibliometric techniques and social network analysis are employed in this study to evaluate 14,955 papers on air pollution and health that were published from 2001 to 2021. To track the research hotspots, the principle of machine learning is applied in this study to divide 10,212 records of keywords into 96 clusters through OmniViz software. Our findings highlight strong research interests and the practical need to control air pollution to improve human health, as evidenced by an annual growth rate of over 15.8% in the related publications. The cluster analysis showed that clusters C22 (exposure, model, mortality) and C8 (health, environment, risk) are the most popular topics in this field of research. Furthermore, we develop co-occurrence networks based on the cluster analysis results in which a more specific keyword classification was obtained. These key areas include: "Air pollutant source", "Exposure-Response relationship", "Public & Occupational Health", and so on. Future research hotspots are analyzed through characteristics of the cluster groups, including the advancement of health risk assessment techniques, an interdisciplinary approach to quantifying human exposure to air pollution, and strategies in health risk assessment.
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Affiliation(s)
- Diyi Liu
- Zhou Enlai School of Government, Nankai University, Tianjin 300071, China
| | - Kun Cheng
- College of Management and Economy, Tianjin University, Tianjin 300072, China
| | - Kevin Huang
- School of Accounting, Economics and Finance, University of Wollongong, Sydney, NSW 2522, Australia
| | - Hui Ding
- School of Marxism, Hangzhou Medical College, Hangzhou 310053, China
| | - Tiantong Xu
- School of E-Business and Logistics, Beijing Technology and Business University, Beijing 100048, China
| | - Zhenni Chen
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yanqi Sun
- School of Economics and Management, Beijing Institute of Petrochemical Technology, Beijing 102617, China
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Zafiraki VK, Kosmacheva ED, Mirzaev SG, Shulzhenko LV, Ramazanov JM, Omarov AA, Imetova ZB, Pershukov IV. Chronic obstructive pulmonary disease in patients with coronary heart disease worsens long-term prognosis after percutaneous coronary interventions. KARDIOLOGIIA 2021; 61:24-32. [PMID: 34882075 DOI: 10.18087/cardio.2021.11.n1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Aim To evaluate the incidence rate of major adverse cardiovascular events (MACVE) in the long-term following percutaneous coronary interventions (PCCI) in patients with acute and chronic ischemic heart disease (IHD) and the contribution of concurrent chronic obstructive pulmonary disease (COPD) to the long-term prediction.Material and methods This prospective cohort study included 254 patients with IHD and concurrent COPD and 392 patients with IHD without COPD. PCCI was performed in all patients: for acute coronary syndrome in 295 patients and for chronic IHD in 351 patients. The follow-up period lasted for up to 36 months. The outcome was a composite endpoint, MACVE, that included cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization (MR), and the time to the event.Results The age-standardized incidence of MACVE in patients with IHD and COPD was 31.5 vs. 23.2 % in patients with IHD without concurrent COPD (p=0.025), primarily due to an increased frequency of repeated unscheduled MR (20.5 vs. 14.0 %, p=0.041), which was associated with earlier occurrence of adverse events (p<0.001). Repeated unscheduled MR was more frequently performed in patients with moderate COPD; the frequency of MR decreased with increasing severity of COPD, whereas the total incidence of cardiovascular death, myocardial infarction, and stroke was the highest in patients with severe and very severe COPD.Conclusion The presence of concurrent COPD increases the relative risk of MACVE 1.36 times (95 % confidence interval: 1.05-1.75) and facilitates their earlier development. Repeated unscheduled MR makes the major contribution to the increase in the total risk (relative risk, 1.46; 95 % confidence interval: 1.03-2.06). The increase in severity of COPD is associated with the increase in total frequency of MACVE (p=0.005).
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Affiliation(s)
- V K Zafiraki
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Regional Clinical Hospital #1, Krasnodar, Russia
| | - E D Kosmacheva
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Scientific Research Institution - S.V.Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - S G Mirzaev
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia
| | - L V Shulzhenko
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Scientific Research Institution - S.V.Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | | | - A A Omarov
- Cardiology and Internal Diseases Institute, Almaty, Kazakhstan
| | | | - I V Pershukov
- Osh State University, Osh, Kyrgyzstan Voronezh Regional Clinical Hospital #1, Voronezh, Russia
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van Eeden SF, Hogg JC. Immune-Modulation in Chronic Obstructive Pulmonary Disease: Current Concepts and Future Strategies. Respiration 2019; 99:550-565. [PMID: 31480060 DOI: 10.1159/000502261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is caused by the chronic inhalation of toxic particles and gases that are primarily but not exclusively derived from cigarette smoke that may be either actively or passively inhaled, which initiates a persistent innate and adaptive immune response in the lung. This immune response is associated with an aberrant tissue repair and remodeling process that results in varying degrees of chronic inflammation with excess production of mucus in the central airways and permanent destruction of the smaller conducting airways and gas exchanging surface in the peripheral lung. Currently, the primary aims of treatment in COPD are bronchodilation (inhaled short- and long-acting β-agonist and antimuscarinic therapies), to control symptoms and nonspecific broad-acting anti-inflammatory agents (inhaled and oral corticosteroids, phosphor-di-esterase inhibitors, and macrolides). That provide symptomatic relief but have little or no impact on either disease progression or mortality. As our understanding of the immune pathogenesis of the COPD improves, available immune modulation therapies have the potential to alter or interfere with damaging immune pathways, thereby slowing relentless progression of lung tissue destruction. The purpose of this brief review is to discuss our current understanding of the immune pathogenesis of both the airways and parenchymal injury as well as the dysfunctional tissue repair process to propose immune modulating interventions in an attempt to stabilize or return these pathological changes to their normal state. The ultimate goal of the immune modulation therapy is to improve both morbidity and mortality associated with COPD.
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Affiliation(s)
- Stephan F van Eeden
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada, .,Pacific Lung Health Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada,
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Association between Beta2-Adrenergic Receptor Agonists and the Risk of Vascular Complications in Diabetic Patients: A Population-Based Cohort Study. J Clin Med 2019; 8:jcm8081145. [PMID: 31370361 PMCID: PMC6722988 DOI: 10.3390/jcm8081145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
Beta2-adrenergic receptor (β2AR) agonists can have protective effects targeting macrophage activation, but research on human subjects has not been done. This study was designed to assess the relationship between the use of β2AR agonists and diabetic vascular complications. Using data from the Korean National Health Insurance Service, adults first diagnosed with diabetes in 2004 (n = 249,222) were followed up until 31 December 2015. Propensity score matching was performed between case and control groups (n = 5179 in each), and multivariate analysis was conducted. The β2AR agonist group was divided into quartiles according to the duration of β2AR agonist use. During the follow-up, the incidence of vascular complications gradually decreased as the duration of β2AR agonist administration increased. Multivariate analysis revealed that the hazard ratio for all composite vascular complications was 0.80 (95% CI, 0.75–0.86, p < 0.001) in the longest quartile of β2AR agonist use as compared with the control group after adjusting for confounding variables. The association between the duration of β2AR agonist use and the risk of each vascular complication including cerebrovascular, peripheral vascular, peripheral neural, renal, and ophthalmic complications was consistent, and the risks were significantly lower in the longest users than the control group. Long-term use of β2AR agonists may exert a protective effect against diabetic vascular complications.
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Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies. Pharmacol Ther 2019; 198:160-188. [PMID: 30822464 PMCID: PMC7112632 DOI: 10.1016/j.pharmthera.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.
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Dai L, He J, Chen J, Wang T, Liu L, Shen Y, Chen L, Wen F. The association of elevated circulating endocan levels with lung function decline in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3699-3706. [PMID: 30519013 PMCID: PMC6233695 DOI: 10.2147/copd.s175461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Endocan is thought to be a novel inflammatory marker that is associated with a variety of inflammatory diseases. However, its role in the pathogenesis of COPD remains unclear. This study aims to explore the potential role of endocan in COPD. Methods In total, 27 healthy volunteers, 55 COPD patients and 36 acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients were included in the study. Basic demographic characteristics, clinical features and blood samples were collected. Magnetic luminex screening assays were used to detect the concentration of endocan, Fas and Fas ligand (Fas-L) in plasma. Differences between groups were compared using an Independent sample t-test, Welch’s t-test, chi-squared test and Wilcoxon rank sum test. The correlations of plasma endocan with lung function parameters, Fas and Fas-L were analyzed by Pearson’s partial correlation test (adjusted for age, gender, body mass index and smoking history) and multiple linear regression. Results Plasma endocan levels in COPD patients were significantly higher than those in healthy volunteers (509.7±18.25 pg/mL vs 434.8±18.98 pg/mL (P=0.0124)), and AECOPD patients had the highest levels of endocan (524.7±27.18 pg/mL). Correlation analysis showed that circulating endocan had a negative correlation to FEV1/FVC, FEV1/predictive and FVC (adjusted r=−0.213, P=0.03; adjusted r=−0.209, P=0.034; and adjusted r=−0.300, P=0.002, respectively), and had a positive correlation to Fas (adjusted r=0.280, P=0.004). Conclusion Our study shows that elevated circulating endocan levels are associated with reduced lung ventilation function in COPD and AECOPD patients. In addition, endocan may influence apoptosis in COPD, suggesting that endocan may play a role in COPD pathogenesis.
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Affiliation(s)
- Luqi Dai
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, .,Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Junyun He
- Department of Respiratory Medicine, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region of China, Chengdu, Sichuan 610041, China
| | - Jun Chen
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, .,Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Tao Wang
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, .,Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Lian Liu
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, .,Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
| | - Fuqiang Wen
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, .,Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China, ;
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Moualla M, Qualls C, Arynchyn A, Thyagarajan B, Kalhan R, Smith LJ, Carr JJ, Jacobs DR, Sood A. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax 2017; 72:1113-1120. [PMID: 28729298 PMCID: PMC6158777 DOI: 10.1136/thoraxjnl-2016-209125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 05/06/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE Adiposity is associated with low lung function, but the longitudinal relationship between lung function and adiposity is inadequately studied. OBJECTIVE To examine the bidirectional longitudinal associations between rapid decline in lung function and adiposity phenotypes in healthy adults. METHODS This secondary analysis used a 25-year longitudinal dataset from the Coronary Artery Risk Development in Young Adults (CARDIA) study that enrolled 5115 participants. MEASUREMENTS In the first analysis, metabolic syndrome at or before CARDIA year (Y) 10 (Y10) was the predictor, and subsequent rapid decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1) between Y10 and Y20 was the outcome. In the second analysis, rapid decline was the predictor, and incident metabolic syndrome at Y20 and/or Y25 was the outcome. In the third analysis, rapid decline was the predictor, and subsequent CT-assessed regional fat depots at Y25 were the outcome. RESULTS Metabolic syndrome at or before Y10 is temporally associated with rapid decline in FVC between Y10 and Y20 (adjusted p=0.04), but this association was explained by body mass index (BMI) at Y10. Rapid decline in FVC or FEV1 is temporally associated with greater incident metabolic syndrome at Y20 and/or Y25 (adjusted OR 2.10 (1.69, 2.61); p<0.001, and 1.56 (1.26, 1.94); p<0.001, respectively) and greater CT-assessed intrathoracic visceral adiposity at Y25 (adjusted standardised β 0.09; p<0.001 for both analyses). These associations were not explained by BMI levels prior to the outcome measurement. CONCLUSIONS Healthy adults with rapid decline in lung function are at risk for developing metabolic syndrome and for disproportionate accumulation of intrathoracic visceral fat. Metabolic abnormalities may be an early extrapulmonary manifestation of lung impairment that may be preventable by improving lung health.
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Affiliation(s)
- Maan Moualla
- Department of Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Clifford Qualls
- Office of Research, Clinical Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alexander Arynchyn
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bharat Thyagarajan
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota, USA
| | - Ravi Kalhan
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lewis J Smith
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John J Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Akshay Sood
- Department of Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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10
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Morgan AD, Sharma C, Rothnie KJ, Potts J, Smeeth L, Quint JK. Chronic Obstructive Pulmonary Disease and the Risk of Stroke. Ann Am Thorac Soc 2017; 14:754-765. [PMID: 28459623 PMCID: PMC5427743 DOI: 10.1513/annalsats.201611-932sr] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/15/2017] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for cardiovascular diseases such as myocardial infarction. The role of COPD in cerebrovascular disease is, however, less certain. Although earlier studies have suggested that the risk for stroke is also increased in COPD, more recent investigations have generated mixed results. OBJECTIVES The primary objective of our review was to quantify the magnitude of the association between COPD and stroke. We also sought to clarify the nature of the relationship between COPD and stroke by investigating whether the risk of stroke in COPD varies with age, sex, smoking history, and/or type of stroke and whether stroke risk is modified in particular COPD phenotypes. RESULTS The MEDLINE and EMBASE databases were searched in May 2016 to identify articles that compared stroke outcomes in people with and without COPD. Studies were grouped by study design to distinguish those that reported prevalence of stroke (cross-sectional studies) from those that estimated incidence (cohort or case-control studies). In addition, studies were stratified according to study population characteristics, the nature of COPD case definitions, and adjustment for confounding (smoking). Heterogeneity was assessed using the I2 statistic. We identified 5,493 studies, of which 30 met our predefined inclusion criteria. Of the 25 studies that reported prevalence ratios, 11 also estimated prevalence odds ratios. The level of heterogeneity among the included cross-sectional studies did not permit the calculation of pooled ratios, save for a group of four studies that estimated prevalence odds ratios adjusted for smoking (prevalence odds ratio, 1.51; 95% confidence interval, 1.09-2.09; I2 = 45%). All 11 studies that estimated relative risk for nonfatal incident stroke reported increased risk in COPD. Adjustment for smoking invariably reduced the magnitude of the associations. CONCLUSIONS Although both prevalence and incidence of stroke are increased in people with COPD, the weight of evidence does not support the hypothesis that COPD is an independent risk factor for stroke. The possibility remains that COPD is causal in certain subsets of patients with COPD and for certain stroke subtypes.
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Affiliation(s)
- Ann D Morgan
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London
| | - Chetna Sharma
- 2 Faculty of Medical Sciences, University College London; and
| | - Kieran J Rothnie
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London
- 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Potts
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London
| | - Liam Smeeth
- 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer K Quint
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London
- 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Schivo M, Albertson TE, Haczku A, Kenyon NJ, Zeki AA, Kuhn BT, Louie S, Avdalovic MV. Paradigms in chronic obstructive pulmonary disease: phenotypes, immunobiology, and therapy with a focus on vascular disease. J Investig Med 2017; 65:953-963. [PMID: 28258130 DOI: 10.1136/jim-2016-000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous syndrome that represents a major global health burden. COPD phenotypes have recently emerged based on large cohort studies addressing the need to better characterize the syndrome. Though comprehensive phenotyping is still at an early stage, factors such as ethnicity and radiographic, serum, and exhaled breath biomarkers have shown promise. COPD is also an immunological disease where innate and adaptive immune responses to the environment and tobacco smoke are altered. The frequent overlap between COPD and other systemic diseases, such as cardiovascular disease, has influenced COPD therapy, and treatments for both conditions may lead to improved patient outcomes. Here, we discuss current paradigms that center on improving the definition of COPD, understanding the immunological overlap between COPD and vascular inflammation, and the treatment of COPD-with a focus on comorbid cardiovascular disease.
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Affiliation(s)
- Michael Schivo
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Timothy E Albertson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
| | - Angela Haczku
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Nicholas J Kenyon
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Amir A Zeki
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Brooks T Kuhn
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Mark V Avdalovic
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
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Zuo L, Chuang CC, Clark AD, Garrison DE, Kuhlman JL, Sypert DC. Reactive Oxygen Species in COPD-Related Vascular Remodeling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 967:399-411. [PMID: 29047102 DOI: 10.1007/978-3-319-63245-2_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The pathogenesis of chronic obstructive pulmonary disease (COPD) is a multifaceted process involving the alteration of pulmonary vasculature. Such vascular remodeling can be associated with inflammation, shear stress, and hypoxia-conditions commonly seen in patients with lung diseases. Particularly, the overproduction of reactive oxygen species (ROS) in the diseased lungs contributes greatly to pulmonary vascular remodeling. ROS play an important role in vascular homeostasis, yet excessive ROS can alter pulmonary vasculature and impair lung function, as implicated in COPD at all stages. Increased inflammatory cell infiltration and endothelial dysfunction both correspond to the severity of COPD. As a byproduct of vascular remodeling, pulmonary hypertension negatively affects the long-term survival rate of COPD patients. While there is currently no cure for COPD, several treatment options have focused on alleviating COPD symptoms. Interventions such as long-term oxygen therapy, endothelium-targeted treatment, and pharmacological therapies show promising results in improving the life span of COPD patients and attenuating the progression of pulmonary hypertension. In this chapter, we aim to discuss the contributing factors of pulmonary vascular remodeling in COPD with an emphasis on the ROS, as well as potential redox treatments for COPD-related vascular remodeling.
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Affiliation(s)
- Li Zuo
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Chia-Chen Chuang
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Alexander D Clark
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Davis E Garrison
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Jamie L Kuhlman
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - David C Sypert
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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13
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Relationship between FEV1 and Cardiovascular Risk Factors in General Population without Airflow Limitation. Can Respir J 2016; 2016:8319849. [PMID: 28018129 PMCID: PMC5149646 DOI: 10.1155/2016/8319849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. We aimed to determine the value of lung function measurement for predicting cardiovascular (CV) disease by evaluating the association between FEV1 (%) and CV risk factors in general population. Materials and Methods. This was a cross-sectional, retrospective study of subjects above 18 years of age who underwent health examinations. The relationship between FEV1 (%) and presence of carotid plaque and thickened carotid IMT (≥0.8 mm) was analyzed by multiple logistic regression, and the relationship between FEV1 (%) and PWV (%), and serum uric acid was analyzed by multiple linear regression. Various factors were adjusted by using Model 1 and Model 2. Results. 1,003 subjects were enrolled in this study and 96.7% (n = 970) of the subjects were men. In both models, the odds ratio of the presence of carotid plaque and thickened carotid IMT had no consistent trend and statistical significance. In the analysis of the PWV (%) and uric acid, there was no significant relationship with FEV1 (%) in both models. Conclusion. FEV1 had no significant relationship with CV risk factors. The result suggests that FEV1 may have no association with CV risk factors or may be insensitive to detecting the association in general population without airflow limitation.
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Morgan AD, Herrett E, De Stavola BL, Smeeth L, Quint JK. COPD disease severity and the risk of venous thromboembolic events: a matched case-control study. Int J Chron Obstruct Pulmon Dis 2016; 11:899-908. [PMID: 27175072 PMCID: PMC4854236 DOI: 10.2147/copd.s100533] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is generally accepted that people with chronic obstructive pulmonary disease (COPD) are at increased risk of vascular disease, including venous thromboembolism (VTE). While it is plausible that the risk of arterial and venous thrombotic events is greater still in certain subgroups of patients with COPD, such as those with more severe airflow limitation or more frequent exacerbations, these associations, in particular those between venous events and COPD severity or exacerbation frequency, remain largely untested in large population cohorts. METHODS A total of 3,594 patients with COPD with a first VTE event recorded during January 1, 2004 to December 31, 2013, were identified from the Clinical Practice Research Datalink dataset and matched on age, sex, and general practitioner practice (1:3) to patients with COPD with no history of VTE (n=10,782). COPD severity was staged by degree of airflow limitation (ie, GOLD stage) and by COPD medication history. Frequent exacerbators were defined as patients with COPD with ≥ 2 exacerbations in the 12-month period prior to their VTE event (for cases) or their selection as a control (for controls). Conditional logistic regression was used to estimate the association between disease severity or exacerbation frequency and VTE. RESULTS After additional adjustment for nonmatching confounders, including body mass index, smoking, and heart-related comorbidities, there was evidence for an association between increased disease severity and VTE when severity was measured either in terms of lung function impairment (odds ratio [OR]moderate:mild =1.16; 95% confidence intervals [CIs] =1.03, 1.32) or medication usage (ORsevere:mild/moderate =1.17; 95% CIs =1.06, 1.26). However, there was no evidence to suggest that frequent exacerbators were at greater risk of VTE compared with infrequent exacerbators (OR =1.06; 95% CIs =0.97, 1.15). CONCLUSION COPD severity defined by airflow limitation or medication usage, but not exacerbation frequency, appears to be associated with VTE events in people with COPD. This finding highlights the disconnect between disease activity and severity in COPD.
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Affiliation(s)
- Ann D Morgan
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Bianca L De Stavola
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer K Quint
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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16
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Windsor C, Herrett E, Smeeth L, Quint JK. No association between exacerbation frequency and stroke in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:217-25. [PMID: 26893553 PMCID: PMC4745831 DOI: 10.2147/copd.s95775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of stroke than the general population. Chronic inflammation associated with COPD is thought to contribute to this risk. Exacerbations of COPD are associated with a rise in inflammation, suggesting that there may be an association between exacerbation frequency and the risk of stroke. This study examined that association. Methods Using the UK Clinical Practice Research Datalink, COPD patients with a first stroke between January 2004 and December 2013 were identified as cases and matched on age, sex, and general practice to controls with COPD but without a stroke (6,441 cases and 19,323 controls). Frequent exacerbators (FEs) were defined as COPD patients with ≥2 exacerbations, and infrequent exacerbators (IEs) have ≤1 exacerbation in the year prior to their stroke. Conditional logistic regression was used to estimate the association between exacerbation frequency and stroke overall, and by stroke subtype (hemorrhagic, ischemic, or transient ischemic attack). Exacerbations were also categorized into 0, 1, 2, or ≥3 exacerbations in the year prior to stroke. Results There was no evidence that FE had an increased odds of stroke compared to IE (OR [odds ratio] =0.95, 95% CI [confidence interval] =0.89–1.01). There was strong evidence that the risk of stroke decreased with each exacerbation of COPD experienced per year (Ptrend =0.003). In the subgroup analysis investigating stroke subtype, FE had 33% lower odds of hemorrhagic stroke than IE (OR =0.67, 95% CI =0.51–0.88, P=0.003). No association was found within other stroke types. Conclusion This study found no evidence of a difference in the odds of stroke between IE and FE, suggesting that exacerbation frequency is unlikely to be the reason for increased stroke risk among COPD patients. Further research is needed to explore the association through investigation of stroke risk and the severity, duration, treatment of exacerbations, and concurrent treatment of cardiovascular risk factors.
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Affiliation(s)
- Claire Windsor
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Kathleen Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
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Inflammation and Inflammatory Diseases, Markers, and Mediators: Role of CRP in Some Inflammatory Diseases. BIOLOGY OF C REACTIVE PROTEIN IN HEALTH AND DISEASE 2016. [PMCID: PMC7122703 DOI: 10.1007/978-81-322-2680-2_4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Targeting oxidant-dependent mechanisms for the treatment of COPD and its comorbidities. Pharmacol Ther 2015; 155:60-79. [PMID: 26297673 DOI: 10.1016/j.pharmthera.2015.08.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 12/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an incurable global health burden and is characterised by progressive airflow limitation and loss of lung function. In addition to the pulmonary impact of the disease, COPD patients often develop comorbid diseases such as cardiovascular disease, skeletal muscle wasting, lung cancer and osteoporosis. One key feature of COPD, yet often underappreciated, is the contribution of oxidative stress in the onset and development of the disease. Patients experience an increased burden of oxidative stress due to the combined effects of excess reactive oxygen species (ROS) and nitrogen species (RNS) generation, antioxidant depletion and reduced antioxidant enzyme activity. Currently, there is a lack of effective treatments for COPD, and an even greater lack of research regarding interventions that treat both COPD and its comorbidities. Due to the involvement of oxidative stress in the pathogenesis of COPD and many of its comorbidities, a unique therapeutic opportunity arises where the treatment of a multitude of diseases may be possible with only one therapeutic target. In this review, oxidative stress and the roles of ROS/RNS in the context of COPD and comorbid cardiovascular disease, skeletal muscle wasting, lung cancer, and osteoporosis are discussed and the potential for therapeutic benefit of anti-oxidative treatment in these conditions is outlined. Because of the unique interplay between oxidative stress and these diseases, oxidative stress represents a novel target for the treatment of COPD and its comorbidities.
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19
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Lin HW, Chung CL, Lin YS, Yu CM, Lee CN, Bien MY. Inhaled Pharmacotherapy and Stroke Risk in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Population Based Study Using Two-Stage Approach. PLoS One 2015; 10:e0130102. [PMID: 26158649 PMCID: PMC4497597 DOI: 10.1371/journal.pone.0130102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/15/2015] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke than those without COPD. This study aims to explore the impact of inhaled pharmacotherapy on stroke risk in COPD patients during a three-year follow-up, using a nationwide, population-based study and a matched cohort design. Methods The study cohort comprised 10,413 patients who had received COPD treatment between 2004 and 2006; 41,652 randomly selected subjects comprised the comparison cohort. Cox proportional hazard regressions and two-stage propensity score calibration were performed to determine the impact of various inhaled therapies including short-acting muscarinic antagonists, long-acting muscarinic antagonists, short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), and LABA plus inhaled corticosteroid (ICS), on the risk after adjustment for patient demographic characteristics and comorbid disorders. Results Of the 52,065 sampled patients, 2,689 (5.2%) developed stroke during follow-up, including 727 (7.0%) from the COPD cohort and 1,962 (4.7%) from the comparison cohort (p < 0.001). Treatment with SABA was associated with 1.67-fold (95% CI 1.45–1.91; p < 0.001) increased risk of stroke in COPD patients. By contrast, the cumulative incidence of stroke was significantly lower in those treated with LABA plus ICS than those treated without (adjusted hazard ratio 0.75, 95% CI 0.60–0.94, p = 0.014). Conclusions Among COPD patients, the use of inhaled SABA is associated with an increased risk of stroke, and combination treatment with inhaled LABA and ICS relates to a risk reduction. Further prospective research is needed to verify whether LABA plus ICS confers protection against stroke in patients with COPD.
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Affiliation(s)
- Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
| | - Chi-Li Chung
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - You Shuei Lin
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Ming Yu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Nin Lee
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mauo-Ying Bien
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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20
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Jairam PM, de Jong PA, Mali WPTM, Isgum I, van der Graaf Y. Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value? Eur Radiol 2015; 25:1646-54. [PMID: 25773934 PMCID: PMC4419189 DOI: 10.1007/s00330-014-3495-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/16/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Objective Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings. Methods A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification. Results During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71–0.74) to 0.74 (95 % CI 0.72–0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)). Conclusion Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans. Key Points • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features Electronic supplementary material The online version of this article (doi:10.1007/s00330-014-3495-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pushpa M Jairam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands,
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21
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Uz O, Kucuk U. eComment. Chronic obstructive pulmonary disease and plaque vulnerability. Interact Cardiovasc Thorac Surg 2015; 20:444. [PMID: 25678676 DOI: 10.1093/icvts/ivu453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Omer Uz
- GATA Haydarpasa Training Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ugur Kucuk
- GATA Haydarpasa Training Hospital, Department of Cardiology, Istanbul, Turkey
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Neilan TG, Bakker JP, Sharma B, Owens RL, Farhad H, Shah RV, Abbasi SA, Kohli P, Wilson J, DeMaria A, Jerosch-Herold M, Kwong RY, Malhotra A. T1 measurements for detection of expansion of the myocardial extracellular volume in chronic obstructive pulmonary disease. Can J Cardiol 2014; 30:1668-75. [PMID: 25442461 PMCID: PMC4258158 DOI: 10.1016/j.cjca.2014.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to assess whether chronic obstructive pulmonary disease (COPD) is associated with expansion of the myocardial extracellular volume (ECV) using T1 measurements. METHODS Adult COPD patients Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2 or higher and free of known cardiovascular disease were recruited. All study patients underwent measures of pulmonary function, 6-minute walk test, serum measures of inflammation, overnight polysomnography, and a contrast cardiac magnetic resonance study. RESULTS Eight patients with COPD were compared with 8 healthy control subjects. The mean predicted forced expiratory volume at 1 second of COPD subjects was 68%. Compared with control subjects, patients had normal left ventricular (LV) and right ventricular size, mass, and function. However, compared with control subjects, the LV remodelling index (median, 0.87; interquartile range [IQR], 0.71-1.14; vs median, 0.62; IQR, 0.60-0.77; P ¼ 0.03) and active left atrial emptying fraction was increased (median, 46; IQR, 41-49; vs median, 38; IQR, 33-43; P ¼ 0.005), and passive left atrial emptying fraction was reduced (median, 24; IQR, 20-30; vs median, 44; IQR, 31-51; P ¼ 0.007). The ECV was increased in patients with COPD (median, 0.32; IQR, 0.05; vs median, 0.27; IQR, 0.05; P = 0.001). The ECV showed a strong positive association with LV remodelling (r = 0.72; P = 0.04) and an inverse association with the 6-minute walk duration (r = -0.79; P = 0.02) and passive left atrial emptying fraction (r = -0.68; P = 0.003). CONCLUSIONS Expansion of the ECV, suggestive of diffuse myocardial fibrosis, is present in COPD and is associated with LV remodelling, and reduced left atrial function and exercise capacity.
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Affiliation(s)
- Tomas G Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital; Cardiac MR PET CT Program, Division of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessie P Bakker
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Bhavneesh Sharma
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert L Owens
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hoshang Farhad
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ravi V Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Siddique A Abbasi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Puja Kohli
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joel Wilson
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, USA
| | - Anthony DeMaria
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Atul Malhotra
- Pulmonary and Critical Care Division, University of California San Diego, San Diego, California, USA
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Roche N, Chavaillon JM, Maurer C, Zureik M, Piquet J. A clinical in-hospital prognostic score for acute exacerbations of COPD. Respir Res 2014; 15:99. [PMID: 25158759 PMCID: PMC4244057 DOI: 10.1186/s12931-014-0099-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/13/2014] [Indexed: 11/27/2022] Open
Abstract
Background The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD (AECOPD). We previously developed a score (‘2008 score’, based on age, dyspnea grade at steady state and number of clinical signs of severity) predicting in-hospital mortality in patients with AECOPD visiting emergency departments (EDs). External validity of this score remained to be assessed. Objectives To test the predictive properties of the ‘2008 score’ in a population of patients hospitalized in medical respiratory wards for AECOPD, and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance. Methods Data from a cohort study in 1824 patients hospitalized in a medical ward for an AECOPD were analyzed. Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed. A new score was developed using multivariate logistic regression modeling in a randomly selected derivation population sample followed by testing in the remaining population (validation sample). Robustness of results was assessed by case-by-case validation. Results The 2008 score was characterized by a c-statistic at 0.77, a sensitivity of 69% and a specificity of 76% for prediction of in-hospital mortality. The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78, a sensitivity of 77% and specificity of 66%. Conclusions A score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AECOPD. Adding cardiac comorbidities to the original score increased its sensitivity while decreasing its specificity. Electronic supplementary material The online version of this article (doi:10.1186/s12931-014-0099-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicolas Roche
- Respiratory and Intensive Care Medicine department, Cochin Hospital Group, APHP, University Paris Descartes (EA2511), Paris, 75005, France.
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Survival Benefit of CPAP Favors Hypercapnic Patients with the Overlap Syndrome. Lung 2014; 192:633-4. [DOI: 10.1007/s00408-014-9614-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 06/09/2014] [Indexed: 01/30/2023]
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25
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Pike D, Kirby M, Lindenmaier TJ, Sheikh K, Neron CE, Hackam DG, Spence JD, Fenster A, Paterson NAM, Sin DD, Coxson HO, McCormack DG, Parraga G. Pulmonary Abnormalities and Carotid Atherosclerosis in Ex-Smokers without Airflow Limitation. COPD 2014; 12:62-70. [DOI: 10.3109/15412555.2014.908833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Therapeutic potential of p38 MAP kinase inhibition in the management of cardiovascular disease. Am J Cardiovasc Drugs 2014; 14:155-65. [PMID: 24504769 DOI: 10.1007/s40256-014-0063-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
p38 mitogen-activated protein kinases (p38 MAPKs) are key signalling molecules that regulate cellular behavior in response to environmental stresses. They regulate pro-inflammatory cytokines and therefore p38 MAPKs are implicated in the pathogenesis of many inflammatory-driven conditions, including atherosclerosis. Therapeutic inhibition of p38 MAPKs to attenuate inflammation has been the focus of comprehensive research in the last 2 decades, following the discovery of p38α as the molecular target of pyrindinyl imidazole compounds, which suppress the cytokines tumor necrosis factor-α and interleukin-1. The potential of p38 MAPK inhibitors was initially explored within archetypal inflammatory conditions such as rheumatoid arthritis and Crohn's disease, but early studies demonstrated poor clinical efficacy and unacceptable side effects. Subsequent clinical trials evaluating different p38 MAPK inhibitor compounds in disease models such as chronic obstructive pulmonary disease (COPD) and atherosclerosis have shown potential clinical efficacy. This review aims to provide succinct background information regarding the p38 MAPK signaling pathway, a focus of p38 MAPKs in disease, and a brief summary of relevant pre-clinical studies. An update of human clinical trial experience encompassing a clinically orientated approach, dedicated to cardiovascular disease follows. It provides a current perspective of the therapeutic potential of p38 MAPK inhibitors in the cardiovascular domain, including safety, tolerability, and pharmacokinetics.
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Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links. BIOMED RESEARCH INTERNATIONAL 2014; 2014:528789. [PMID: 24724085 PMCID: PMC3958649 DOI: 10.1155/2014/528789] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/16/2013] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.
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Affiliation(s)
- Cheryl R Laratta
- Department of Medicine, University of Alberta, Edmonton, AB, Canada ; UBC James Hogg Research Center, Institute for Heart and Lung Health, University of British Columbia, Canada
| | - Stephan van Eeden
- UBC James Hogg Research Center, Institute for Heart and Lung Health, University of British Columbia, Canada ; Respiratory Division, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada
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Wierzbicki AS, Louis R. Lipid-lowering drug therapies and chronic obstructive pulmonary disease: lung failure or just heart failure? Int J Clin Pract 2014; 68:144-51. [PMID: 24460612 DOI: 10.1111/ijcp.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 09/17/2013] [Indexed: 12/15/2022] Open
Affiliation(s)
- A S Wierzbicki
- Guy's & St. Thomas' Hospitals, St Thomas' Hospital Campus, London, UK
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Pike D, Lindenmaier TJ, Sin DD, Parraga G. Imaging evidence of the relationship between atherosclerosis and chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/iim.13.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roversi S, Roversi P, Spadafora G, Rossi R, Fabbri LM. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014; 44:93-102. [PMID: 24164255 DOI: 10.1111/eci.12181] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/19/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Numerous epidemiologic studies have linked the presence of chronic obstructive pulmonary disease (COPD) to coronary artery disease (CAD). However, prevalence, pathological processes, clinical manifestations and therapy are still debated, as progress towards uncovering the link between these two disorders has been hindered by the complex nature of multimorbidity. METHODS Articles targeting CAD in patients with COPD were identified from the searches of MEDLINE and EMBASE databases in July 2013. Three authors reviewed available evidence, focusing on the latest development on disease prevalence, pathogenesis, clinical manifestations and therapeutic strategies. Both clinical trial and previous reviews have been included in this work. RESULTS The most accredited hypothesis asserts that the main common risk factors, that is, cigarette smoke and ageing, elicit a chronic low-grade systemic inflammatory response, which affects both cardiovascular endothelial cells and airways/lung parenchyma. The development of CAD in patients with COPD potentiates the morbidity of COPD, leading to increased hospitalizations, mortality and health costs. Moreover, correct diagnosis is challenging and therapies are not clearly defined. CONCLUSIONS Evidence from recently published articles highlights the importance of multimorbidity in patient management and future research. Moreover, many authors emphasize the importance of low-grade systemic inflammation as a common pathological mechanism and a possible future therapeutic target.
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Affiliation(s)
- Sara Roversi
- Section of Cardiology, Department of Medicine and Emergency Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Abstract
Cardiovascular disease is the leading cause of death in women, contributing to one in three female deaths. Despite improvements in overall cardiovascular outcomes, substantial gender and ethnic disparities remain. In order to improve outcomes among women, we recommend the following: every woman should undergo risk stratification for short-term and lifetime cardiovascular risk given the substantial long-term risk of cardiovascular disease; modifiable cardiovascular risk factors in women should be modified to the greatest extent possible; and these factors include lipid abnormalities, hypertension, smoking, diabetes, obesity, physical inactivity and, possibly, inflammatory markers. The rate of decline in heart disease is slower for women than men, highlighting the need for gender-specific interventions to address the outcomes gap.
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Affiliation(s)
- Tamer Sallam
- David Geffen School of Medicine, Division of Cardiology, Department of Medicine, University of California, Los Angeles, 650 Charles E Drive South, A-2237 CHS, Box 951679, Los Angeles, CA 90095 1679, USA
| | - Karol E Watson
- David Geffen School of Medicine, Division of Cardiology, Department of Medicine, University of California, Los Angeles, 650 Charles E Drive South, A-2237 CHS, Box 951679, Los Angeles, CA 90095 1679, USA
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Mirrakhimov AE, Mirrakhimov EM. Chronic Obstructive Pulmonary Disease and Vascular Risk: Should We Account for Diabetes Mellitus and Renal Disease? Can J Cardiol 2013; 29:639.e9. [DOI: 10.1016/j.cjca.2012.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 10/28/2012] [Indexed: 11/26/2022] Open
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Park HY, Man SFP, Tashkin D, Wise RA, Connett JE, Anthonisen NA, Sin DD. The relation of serum myeloperoxidase to disease progression and mortality in patients with chronic obstructive pulmonary disease (COPD). PLoS One 2013; 8:e61315. [PMID: 23637811 PMCID: PMC3630209 DOI: 10.1371/journal.pone.0061315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/08/2013] [Indexed: 11/18/2022] Open
Abstract
Myeloperoxidase is a strong oxidant stored in primary granules of neutrophils with potent antibacterial and proatherogenic properties. Myeloperoxidase has been implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the relationship of myeloperoxidase to health outcomes in COPD is not well known. We measured serum myeloperoxidase levels from 4,677 subjects with mild to moderate airflow limitation in the Lung Health Study. Using a Cox proportional hazards model, we determined the relationship of serum myeloperoxidase concentration to the risk of all-cause and disease specific causes of mortality. We found that serum myeloperoxidase concentrations were significantly related to accelerated decline in forced expiratory volume in 1 second (FEV1) over 11 years of follow-up (p<0.0001), and this association persisted after adjustments for age, sex, race, baseline FEV1, and smoking status (p = 0.048). Serum myeloperoxidase concentrations were also associated with increased risk of cardiovascular mortality (p = 0.036). Individuals in the highest quintile of myeloperoxidase had a hazard ratio of cardiovascular mortality of 1.90 (95% confidence interval 1.00–3.58; p = 0.049) compared with those in the lowest quintile, which was particularly notable in patients who continued to smoke (adjusted p-value of 0.0396). However, serum myeloperoxidase concentration was not related to total mortality, respiratory mortality, or deaths from malignancies. In conclusion, increased serum myeloperoxidase levels are associated with rapid lung function decline and poor cardiovascular outcomes in COPD patients, which support the emerging role of myeloperoxidase in the pathogenesis of COPD progression and cardiovascular disease.
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Affiliation(s)
- Hye Yun Park
- UBC James Hogg Research Center and The Institute of Heart and Lung Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Seoul, S. Korea
| | - S. F. Paul Man
- UBC James Hogg Research Center and The Institute of Heart and Lung Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - John E. Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Don D. Sin
- UBC James Hogg Research Center and The Institute of Heart and Lung Institute, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Fisk M, Mohan D, Cheriyan J, Yang L, Fuld J, McEniery C, Tal-Singer R, Polkey M, Wilkinson I. Evaluation of losmapimod in patients with chronic obstructive pulmonary disease (COPD) with systemic inflammation stratified using fibrinogen (‘EVOLUTION’): Rationale and protocol. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Inflammation and biomarkers in vascular disease: emerging insights and opportunities. Can J Cardiol 2012; 28:616-8. [PMID: 23146337 DOI: 10.1016/j.cjca.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 09/30/2012] [Indexed: 11/22/2022] Open
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