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Cheng ZJ, Wu H, Chang Z, Cheng J, Wang S, Liu C, Zhang Y, Xu S, Wan Q, Ron J, Liu K, Sun B. The genetic etiology of body fluids on chronic obstructive airways disease. Respir Res 2024; 25:46. [PMID: 38243265 PMCID: PMC10797732 DOI: 10.1186/s12931-023-02661-6] [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: 10/18/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Numerous studies have documented significant alterations in the bodily fluids of Chronic Obstructive Pulmonary Disease (COPD) patients. However, existing literature lacks causal inference due to residual confounding and reverse causality. METHODS Summary-level data for COPD were obtained from two national biobanks: the UK Biobank, comprising 1,605 cases and 461,328 controls, and FinnGen, with 6,915 cases and 186,723 controls. We also validated our findings using clinical data from 2,690 COPD patients and 3,357 healthy controls from the First Affiliated Hospital of Guangzhou Medical University. A total of 44 bodily fluid biomarkers were selected as candidate risk factors. Mendelian randomization (MR) and meta-analyses were used to evaluate the causal effects of these bodily fluids on COPD and lung function (FEV1/FVC). RESULTS Mendelian randomization (MR) and meta-analyses, by integrating data from the UK Biobank and FinnGen cohort, found that 3 bodily fluids indicators (HDLC, EOS, and TP) were causally associated with the risk of COPD, two (EOS and TP) of which is consistent with our observational findings. Moreover, we noticed EOS and TP were causally associated with the risk of lung function (FEV1/FVC). CONCLUSIONS The MR findings and clinical data highlight the independent and significant roles of EOS and TP in the development of COPD and lung function (FEV1/FVC), which might provide a deeper insight into COPD risk factors and supply potential preventative strategies.
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Affiliation(s)
- Zhangkai J Cheng
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangzhou, 510005, Guangdong Province, China
| | - Haojie Wu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Zhenglin Chang
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangzhou, 510005, Guangdong Province, China
| | - Jiahao Cheng
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Suilin Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changlian Liu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Yanxi Zhang
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Shiliang Xu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Qiongqiong Wan
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - JinWen Ron
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Kemin Liu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
| | - Baoqing Sun
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangzhou, 510005, Guangdong Province, China.
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Lin H, Lu Y, Lin L, Meng K, Fan J. Does chronic obstructive pulmonary disease relate to poor prognosis in patients with lung cancer?: A meta-analysis. Medicine (Baltimore) 2019; 98:e14837. [PMID: 30882673 PMCID: PMC6426564 DOI: 10.1097/md.0000000000014837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nowadays, there is growing recognition that chronic obstructive pulmonary disease (COPD) may have influence on lung cancer. However, coexisted COPD related to prognosis of lung cancer is still elusive. We conducted this meta-analysis to examine the association between COPD and 5-year overall survival (OS) and postoperative pulmonary complications of patients with lung cancer. METHODS A comprehensive computer-based online search was conducted using PubMed, Embase, Medline, and the Cochrane Library for articles published before September 30, 2017. We identified 29 eligible studies, which included 70,111 patients in the related literature. RESULTS Twenty-two of the 29 studies provided hazard ratio for OS (1.18, 95% confidence interval: 1.11-1.25; P < .001), it suggested that the presence of COPD indicated poor survival for the patients with lung cancer. In subgroup analysis, the relationship between COPD and OS occurrence remained statistically prominent in the subgroups stratified by study designs, COPD diagnosis timing, lung cancer surgery, cancer stage, and origins of patients. The presence of COPD increased the risk of bronchopleural fistula, pneumonia, prolonged air leakage, and prolonged mechanical ventilation. CONCLUSIONS The present meta-analysis suggested that coexisting COPD is associated with poor survival outcomes in patients with lung cancer and higher rates of postoperative pulmonary complications.
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Affiliation(s)
- Hefeng Lin
- The Second Affiliated Hospital, School of Medicine
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunlong Lu
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Liya Lin
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Meng
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Junqiang Fan
- The Second Affiliated Hospital, School of Medicine
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Laforest L, Roche N, Devouassoux G, Belhassen M, Chouaid C, Ginoux M, Van Ganse E. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: A population-based cohort study. Respir Med 2016; 117:33-9. [DOI: 10.1016/j.rmed.2016.05.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 12/24/2022]
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Marcun R, Stankovic I, Vidakovic R, Farkas J, Kadivec S, Putnikovic B, Ilic I, Neskovic AN, Lainscak M. Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease. Intern Emerg Med 2016; 11:519-27. [PMID: 26423072 DOI: 10.1007/s11739-015-1319-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/28/2015] [Indexed: 01/14/2023]
Abstract
Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44-2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I-III, HR 2.37, CI 1.23-4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12-6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival.
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Affiliation(s)
- Robert Marcun
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ivan Stankovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia.
| | - Radosav Vidakovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Jerneja Farkas
- Chair of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sasa Kadivec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Biljana Putnikovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Ivan Ilic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Mitja Lainscak
- Department of Cardiology, General Hospital Celje, Oblakova cesta 5, 3000, Celje, Slovenia
- Chair of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Caram LMDO, Ferrari R, Naves CR, Coelho LS, do Vale SA, Tanni SE, Godoy I. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD. J Bras Pneumol 2016; 42:179-84. [PMID: 27383930 PMCID: PMC5569610 DOI: 10.1590/s1806-37562015000000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. METHODS The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. RESULTS Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively). The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. CONCLUSIONS Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression), appear to be more prevalent in patients with mild-to-moderate COPD. OBJETIVO Avaliar e comparar a prevalência de comorbidades e de fatores de risco de doença cardiovascular (DCV) em pacientes com DPOC de acordo com a gravidade da doença. MÉTODOS O estudo incluiu 25 pacientes com DPOC leve/moderada (homens: 68%; média de idade: 65 ± 8 anos; média de VEF1: 73 ± 15% do previsto) e 25 com DPOC grave/muito grave (homens: 56%; média de idade: 69 ± 9 anos; média de VEF1, 40 ± 18% do previsto). As comorbidades foram registradas com base nos dados dos prontuários médicos e avaliações clínicas. O índice de comorbidades de Charlson foi calculado, e a pontuação na Hospital Anxiety and Depression Scale (HADS) foi determinada. RESULTADOS Dos 50 pacientes avaliados, 38 (76%) receberam diagnóstico de pelo menos uma comorbidade, sendo que 21 (42%) receberam diagnóstico de pelo menos uma DCV. Vinte e quatro pacientes (48%) apresentavam mais de uma DCV. Dezoito pacientes (36%) eram fumantes, 10 (20%) tinham depressão, 7 (14%) apresentavam dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p < 0,001, p = 0,008 e p = 0,02, respectivamente). A prevalência de pressão arterial elevada, diabetes mellitus, alcoolismo, doença isquêmica do coração e insuficiência cardíaca crônica foi semelhante nos dois grupos. O índice de comorbidades de Charlson e a pontuação na HADS não diferiram entre os grupos. CONCLUSÕES Comorbidades são muito prevalentes na DPOC, independentemente da gravidade da doença. Certos fatores de risco de DCV, eles próprios considerados doenças (incluindo tabagismo, dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.
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Affiliation(s)
- Laura Miranda de Oliveira Caram
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Renata Ferrari
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Cristiane Roberta Naves
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Simone Alves do Vale
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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Khazdair MR, Boskabady MH, Ghorani V. Respiratory effects of sulfur mustard exposure, similarities and differences with asthma and COPD. Inhal Toxicol 2015; 27:731-44. [PMID: 26635274 DOI: 10.3109/08958378.2015.1114056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Previous research has found relationships between sulfur mustard (SM) toxicity and its adverse effects. OBJECTIVE SM is highly toxic to the respiratory system, leading to hacking cough, rhinorrheachest tightness, acute pharyngitis and laryngitis, chronic bronchitis and lung fibrosis. In this review, based on the scientific literature, we provide an updated summary of information on SM exposures and their differences with asthma and COPD. METHOD Information of this review was obtained by searching Medline/PubMed, ScienceDirect, Scopus, Google Scholar, ISI Web of Knowledge and Chemical Abstracts. RESULTS SM exposure can decrease pulmonary function tests (PFTs) values. In addition, inflammatory cell accumulation in the respiratory tract and increased expression of some pro-inflammatory cytokines including tumor necrosis factor-α (TNFα), IL-1a, IL-1β, and reactive oxygen radicals due to SM exposure have been shown. Matrix metalloproteinase (MMP) which degrade extracellular matrix proteins, contributing to inflammatory cell recruitment, tissue injury and fibrosis are also up-regulated in the lung after SM exposure. In the lung, SM exposure also can cause serious pathological changes including airway inflammation, parenchymal tissue destruction and airway obstruction which can lead to asthma or chronic obstructive pulmonary disease (COPD). Following SM poisoning, DNA damage, apoptosis and autophagy are observed in the lung along with the increased expression of activated caspases and DNA repair enzymes. CONCLUSION In the present article, respiratory symptoms, changes in PFTs, lung pathology and lung inflammation due to SM exposure and the similarities and differences between them and those observed in asthma and COPD were reviewed.
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Affiliation(s)
- Mohammad Reza Khazdair
- a Pharmaceutical Research Center and Department of Physiology, School of Medicine .,b Student Research Committee , and
| | - Mohammad Hossein Boskabady
- c Neurogenic Inflammation Research Centre and Department of Physiology, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Vahideh Ghorani
- a Pharmaceutical Research Center and Department of Physiology, School of Medicine
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Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), prevalence and association with disease severity: Using tissue Doppler study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lipid profile and statin use: the paradox of survival after acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci 2015; 349:338-43. [PMID: 25719977 DOI: 10.1097/maj.0000000000000435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A paradoxical association between cholesterol level and clinical outcome has been suggested, yet never previously established, in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES The authors sought to investigate the interaction between long-term survival, lipid profile and statin use in patients after acute exacerbation of COPD (AECOPD). METHODS A retrospective study evaluating demographic, clinical and laboratory data of 615 consecutive patients admitted for AECOPD over a mean follow-up period of 24.8 months. Kaplan-Meier survival curves and multivariate analysis were used to identify independent prognostic predictors for all-cause mortality. RESULTS Mean ± standard deviation (SD) age of the study population was 71.8 ± 11.4 years. Unexpectedly, mean serum cholesterol ± SD levels were significantly higher in survivors (N = 340) versus nonsurvivors (N = 275): 181.5 ± 43.6 versus 171.6 ± 57.2 mg/dL, respectively, (P = 0.0043). Median survival for patients with cholesterol levels <150 and >200 mg/dL were 16.0 and 64.4 months, respectively (P = 0.0173). On multivariate analysis, cholesterol level <150 mg/dL was an independent predictor of mortality, irrespective of cardiovascular risk factors (hazard ratio [HR] = 1.8430, 95% confidence interval [CI] = 1.2547-2.7072, P = 0.0019). Statin use had an independent protective effect, regardless of cholesterol level (HR = 0.4924, 95% CI = 0.2924-0.8292, P = 0.0080). CONCLUSIONS Low cholesterol levels are significantly associated with increased mortality after AECOPD. Nonetheless, as statin treatment was associated with reduced mortality over the entire range of cholesterol levels, its use should be considered in all COPD patients.
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Chung WS, Chu YH, Lin CL, Kao CH. Increased risk of acute coronary syndrome among leptospirosis patients: A nationwide cohort analysis. Int J Cardiol 2015; 184:576-580. [PMID: 25769002 DOI: 10.1016/j.ijcard.2015.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies on the association between leptospirosis and acute coronary syndrome (ACS) are lacking. Therefore, this study identifies the effects of leptospirosis on the risks of developing ACS with a nationwide retrospective cohort study. METHODS We identified adult patients aged ≥20 years who were newly diagnosed with leptospirosis. We also randomly selected a comparison cohort from the general population by using a propensity score matching method. We analyzed the risks of ACS by using Cox proportional hazard regression models. RESULTS Among the 23.74 million people in the cohort, 3690 patients with leptospirosis (68% men, mean age of 52.2 years) and 3690 controls were followed for 13,677 and 15,652 person-years, respectively. The overall incidence of ACS was higher in the leptospirosis cohort than in the nonleptospirosis cohort (4.68 vs 3.71 per 1000 person-years), with a hazard ratio (HR) of 1.69 (95% confidence interval [CI]=1.12-2.56). Men exhibited a 1.88-fold greater HR of ACS than women did (95% CI=1.20-2.94). The risk of developing ACS was highest for leptospirosis patients aged ≥65 years (HR=7, 51% CI=4.35-12.9) compared with patients aged ≤49 years. CONCLUSION Leptospirosis is not a previously identified risk factor for ACS. The findings of this nationwide retrospective cohort study indicate that leptospirosis may become an independent risk factor for ACS. Future research to investigate the mechanism is warranted.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yung-Hua Chu
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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d-dimer as a Prognostic Biomarker for Mortality in Chronic Obstructive Pulmonary Disease Exacerbation. Am J Med Sci 2015; 349:29-35. [DOI: 10.1097/maj.0000000000000332] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chung WS, Shen TC, Lin CL, Chu YH, Hsu WH, Kao CH. Adult asthmatics increase the risk of acute coronary syndrome: A nationwide population-based cohort study. Eur J Intern Med 2014; 25:941-5. [PMID: 25468246 DOI: 10.1016/j.ejim.2014.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Few studies have examined the risk of acute coronary syndrome (ACS) in asthmatics. We investigate the effects of asthma on the risk of ACS development in an Asian population. METHODS Asthma patients aged ≥ 18 years were identified, and asthma-free controls were randomly selected from the general population and frequency-matched according to age, sex, index year, and baseline comorbidity by using the National Health Insurance Research Database. Both cohorts were followed up until the end of 2011 to measure the incidence of ACS. The risk of ACS was analyzed using Cox proportional hazards regression models. RESULTS We observed the asthmatic patients for 97,506 person-years and followed the nonasthmatic people for 193,423 person-years. The incidence density rate of ACS increased in all groups of the asthmatic patients compared with those of the controls when the data were stratified according to sex, age, and comorbidities. The hazard ratio (HR) of ACS was 1.66-fold greater in the asthmatic cohort than in the nonasthmatic cohort, after adjusting for sex, age, and comorbidities (95% confidence interval [CI]: 1.31-2.11). The adjusted HR of developing ACS increased substantially as age and the frequency of asthmatic exacerbation and hospitalization increased. CONCLUSIONS Asthma is an independent risk factor of ACS, and poor control of asthma increases the risk of ACS development in a dose-dependent manner.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- Department of Respiratory and Critical Care, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yung-Hua Chu
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Wu-Huei Hsu
- Department of Respiratory and Critical Care, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Caram LMDO, Ferrari R, Naves CR, Tanni SE, Coelho LS, Zanati SG, Minicucci MF, Godoy I. Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease. Clinics (Sao Paulo) 2013; 68:772-6. [PMID: 23778477 PMCID: PMC3674261 DOI: 10.6061/clinics/2013(06)08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/26/2013] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p<0.05) and blockage of the anterosuperior division of the left bundle branch were higher in patients with greater obstruction. In an echocardiographic analysis, mild/moderate chronic obstructive pulmonary disease patients showed more abnormalities in segmental contractility (p<0.05), whereas severe/very severe chronic obstructive pulmonary disease patients showed a higher prevalence of right ventricular overload (p<0.05), increased right cardiac chamber (p<0.05) and higher values of E-wave deceleration time (p<0.05). Age, sex, systemic arterial hypertension, C-reactive protein and disease were included as independent variables in a multiple linear regression; only disease severity was predictive of the E-wave deceleration time [r²=0.26, p=0.01]. CONCLUSION Chronic obstructive pulmonary disease patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. Because of this association, it is important to exclude decompensated heart failure during chronic obstructive pulmonary disease exacerbation.
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Elevated cardiovascular risk among adults with obstructive and restrictive airway functioning in the United States: a cross-sectional study of the National Health and Nutrition Examination Survey from 2007-2010. Respir Res 2012; 13:115. [PMID: 23237325 PMCID: PMC3546884 DOI: 10.1186/1465-9921-13-115] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States. METHODS We used data from adults aged 20-79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria. RESULTS Among 7249 participants, 80.9% had a normal pulmonary function test, 5.7% had a restrictive impairment, 7.9% had mild obstructive impairment, and 5.5% had moderate or severe/very severe obstructive impairment. Participants with obstructive impairment had high rates of smoking and increased serum concentrations of cotinine. Compared to participants with normal pulmonary functioning, participants with at least moderate obstructive impairment had elevated concentrations of C-reactive protein but lower concentrations of total cholesterol and non-high-density lipoprotein cholesterol. Among participants aged 50-74 years, participants with at least a moderate obstructive impairment or a restrictive impairment had an elevated predicted 10-year risk for cardiovascular disease. CONCLUSIONS The high rates of smoking among adults with impaired pulmonary functioning, particularly those with obstructive impairment, point to a need for aggressive efforts to promote smoking cessation in these adults. In addition, adults with restrictive impairment may require increased attention to and fine-tuning of their cardiovascular risk profile.
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Coronary artery disease is under-diagnosed and under-treated in advanced lung disease. Am J Med 2012; 125:1228.e13-1228.e22. [PMID: 22959785 PMCID: PMC3732035 DOI: 10.1016/j.amjmed.2012.05.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary artery disease is a potentially treatable comorbidity observed frequently in both chronic obstructive pulmonary disease and interstitial lung disease. The prevalence of angiographically proven coronary artery disease in advanced lung disease is not well described. We sought to characterize the treatment patterns of coronary artery disease complicating advanced lung disease and to describe the frequency of occult coronary artery disease in this population. METHODS We performed a 2-center, retrospective cross-sectional study of patients with either chronic obstructive pulmonary disease or interstitial lung disease evaluated for lung transplantation. Medications and diagnoses before the transplant evaluation were recorded in conjunction with left heart catheterization results. RESULTS Of 473 subjects, 351 had chronic obstructive pulmonary disease, and 122 had interstitial lung disease. In subjects diagnosed clinically with coronary artery disease, medical regimens included a statin in 78%, antiplatelet therapy in 62%, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in 42%, and a beta-blocker in 37%. Ten percent were on no medication from these 4 classes. Fifty-seven percent of these subjects were on an antiplatelet agent as well as a statin, and 13% were on neither. Beta-blockers were less frequently prescribed in chronic obstructive pulmonary disease than interstitial lung disease (23% vs 58%, P=.007). Coronary angiography was available in 322 subjects. It demonstrated coronary artery disease in 60% of subjects, and severe coronary artery disease in 16%. Occult coronary artery disease and severe occult coronary artery disease were found in 53% and 9%, respectively. There were no significant differences in angiographic results between chronic obstructive pulmonary disease and interstitial lung disease, despite imbalanced risk factors. CONCLUSIONS Coronary artery disease is common in patients with advanced lung disease attributable to chronic obstructive pulmonary disease or interstitial lung disease and is under-diagnosed. Guideline-recommended cardioprotective medications are suboptimally utilized in this population.
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Alter DA, Ko DT, Tu JV, Stukel TA, Lee DS, Laupacis A, Chong A, Austin PC. The average lifespan of patients discharged from hospital with heart failure. J Gen Intern Med 2012; 27:1171-9. [PMID: 22549300 PMCID: PMC3515002 DOI: 10.1007/s11606-012-2072-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/01/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There are no life-tables quantifying the average life-spans of post-hospitalized heart failure populations across various strata of risk. OBJECTIVE To quantify the life-expectancies (i.e., average life-spans) of heart failure patients at the time of hospital discharge according to age, gender, predictive 30-day mortality heart failure risk index, and comorbidity burden. DESIGN Population-based retrospective cohort study. SETTING Ontario, Canada. PATIENTS 7,865 heart failure patients discharged from Ontario hospitals between 1999 and 2000. MEASUREMENTS Data were obtained from the Enhanced Feedback for Effective Cardiac Treatment EFFECT provincial quality improvement initiative. All patients were linked to administrative data, and tracked longitudinally until March 31, 2010. Detailed clinical variables were obtained from medical chart abstraction, and death data were obtained from vital statistics. Average life-spans were calculated using Cox Proportion Hazards models in conjunction with the Declining Exponential Approximation of Life Expectancy (D.E.A.L.E) method to extrapolate life-expectancy, adjusting for age, gender, predicted 30-day mortality, left ventricular function and comorbidity, and was reported according to key prognostic risk-strata. RESULTS The average life-span of the cohort was 5.5 years (STD +/- 10.0) ranging from 19.5 years for low-risk women of less than 50 years old to 2.9 years for high-risk octogenarian males. Average life-spans were lower by 0.13 years among patients with impaired as compared with preserved left ventricular function, and by approximately one year among patients with three or more as compared with no concomitant comorbidities. In total, 17.4 % and 27 % of patients had died within 6 months and 1 year respectively, despite having predicted life-spans exceeding one-year. LIMITATIONS Data regarding changes in patient clinical status over time were unavailable. CONCLUSIONS The development of risk-adjusted life-tables for heart failure populations is feasible and mirrored those with advanced malignant diseases. Average life span varied widely across clinical risk strata, and may be less accurate among those at or near their end of life.
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Affiliation(s)
- David A Alter
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Prevalence of cardiovascular disease in subjects hospitalized due to chronic obstructive pulmonary disease in Beijing from 2000 to 2010. J Geriatr Cardiol 2012; 9:5-10. [PMID: 22783317 PMCID: PMC3390099 DOI: 10.3724/sp.j.1263.2012.00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate the overall prevalence of cardiovascular disease (CVD) in subjects hospitalized for chronic obstructive pulmonary disease (COPD), and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period. METHODS Medical records in the PLA General Hospital, Beijing Union Medical College Hospital, and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed. A total of 4960 patients with COPD were reviewed in the study (3570 males, mean age, 72.2 ± 10.5 years; 1390 females, mean age, 72.0 ± 10.4 years). RESULTS The prevalence of CVD in COPD patients was 51.7%. The three most prevalent CVDs were ischemic heart disease (28.9%), heart failure (19.6%), and arrhythmia (12.6%). During the 10-year study period, the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age. There was higher morbidity due to ischemic heart disease (P < 0.01) in male COPD patients than in the female counterparts. However, heart failure (P < 0.01) and hypertension (P < 0.01) occurred less frequently in male COPD patients than in female COPD patients. Furthermore, the prevalence of ischemic heart disease decreased year by year. In addition to heart failure, various types of CVD complications in COPD patients tended to occur in younger subjects. The prevalence of all major types of CVD in women tended to increase year by year. CONCLUSIONS The prevalence of CVD in patients hospitalized for COPD in Beijing was high. Age, sex and CVD trends, as well as life style changes, should be considered when prevention and control strategies are formulated.
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Reed RM, Hashmi S, Eberlein M, Iacono A, Netzer G, DeFilippis A, Girgis RE, Toth PP, Scharf S, Jones S. Impact of lung transplantation on serum lipids in COPD. Respir Med 2011; 105:1961-8. [PMID: 22019328 DOI: 10.1016/j.rmed.2011.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/13/2011] [Accepted: 10/05/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease is associated with high HDL cholesterol (HDL-C). We sought to examine the effect of lung transplantation on lipid profiles in patients with COPD. METHODS We analyzed 101 lung transplant recipients in a retrospective cohort of patients from two centers in whom lipid values were available both before as well as after transplantation. Sixty-one subjects were transplanted for severe COPD (93% GOLD stage 4). RESULTS Eighty-nine percent of subjects with COPD exhibited a decline in HDL-C. Median decline for the COPD cohort was 25 mg/dL (IQR 12-38 mg/dL, p < 0.0001). Non-COPD subjects exhibited no significant changes in HDL-C. Other lipid changes in the COPD cohort included a rise in triglycerides of 70 mg/dL (IQR 35 to 140, p < 0.0001). Decreases in HDL-C levels were independent from the rise in triglyceride levels. Neither LDL-C nor non-HDL-C demonstrated significant changes. Subjects with greater increases in prednisone exposure post-transplant exhibited lesser declines in HDL-C. Compared with tacrolimus, cyclosporine had no effect on observed changes in HDL-C or triglycerides, but was associated with a greater median rise in LDL-C. CONCLUSIONS In patients with COPD, lung transplantation results in reductions in the serum levels of HDL-C. These changes are not observed in patients undergoing lung transplantation for diagnoses other than COPD.
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Affiliation(s)
- Robert M Reed
- University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, 110 South Paca Street, Baltimore, MD 21201, USA.
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Reed RM, Iacono A, DeFilippis A, Jones S, Eberlein M, Lechtzin N, Girgis RE. Statin therapy is associated with decreased pulmonary vascular pressures in severe COPD. COPD 2011; 8:96-102. [PMID: 21495837 DOI: 10.3109/15412555.2011.558545] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) in COPD carries a poor prognosis. Statin therapy has been associated with numerous beneficial clinical effects in COPD, including a possible improvement in PH. We examined the association between statin use and pulmonary hemodynamics in a well-characterized cohort of patients undergoing evaluation for lung transplantation. METHODS We conducted a cross-sectional analysis of 112 subjects evaluated for lung transplant with a diagnosis of COPD. Clinical characteristics, pulmonary function, cardiac catheterization findings and medical comorbidities were compared between statins users and non-users. RESULTS Thirty-four (30%) subjects were receiving statin therapy. Statin users were older and had an increased prevalence of systemic hypertension and coronary artery disease (CAD). Mean pulmonary arterial pressure (mPAP) in the statin group was lower [26 ± 7 vs 29 ± 7 mmHg, p = 0.02], as was pulmonary artery wedge pressure (PAWP) [12 ± 5 vs. 15 ± 6 mmHg, p = 0.02]. Pulmonary vascular resistance did not differ between the groups. In multiple regression analysis, statin use was associated with a 4.2 mmHg (95% CI: 2 to 6.4, p = <0.001) lower PAWP and a 2.6 mmHg (95% CI: 0.3 to 4.9, p = 0.03) reduction in mPAP independent of PAWP. CONCLUSIONS In patients with severe COPD, statin use is associated with significantly lower PAWP and mPAP. These finding should be evaluated prospectively.
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Affiliation(s)
- Robert M Reed
- University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland 21201, USA.
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Reed RM, Iacono A, DeFilippis A, Eberlein M, Girgis RE, Jones S. Advanced chronic obstructive pulmonary disease is associated with high levels of high-density lipoprotein cholesterol. J Heart Lung Transplant 2011; 30:674-8. [DOI: 10.1016/j.healun.2010.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/04/2010] [Accepted: 12/12/2010] [Indexed: 11/17/2022] Open
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Gullón JA, Suárez I, Medina A, Rubinos G, Fernández R, González I. Role of emphysema and airway obstruction in prognosis of lung cancer. Lung Cancer 2010; 71:182-5. [PMID: 20554345 DOI: 10.1016/j.lungcan.2010.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 03/15/2010] [Accepted: 05/16/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE It has been reported that the presence of COPD and emphysema is associated with an increased risk of lung cancer, but the prognosis significance of these two conditions is not well known. The aim of our study was to analyze the influence of COPD and emphysema in the prognosis of non-small cell lung cancer (NSCLC). METHODS Three hundred and fifty-three patients with cytohistologic diagnosis of NSCLC were prospectively collected. The relationship between survival at two years and the following variables: age, sex, smoking habit, comorbid diseases (cardiovascular diseases, previous tumour and COPD), weight loss, presence of emphysema on CT scan, performance status (PS) and treatment, was analyzed. The Kaplan-Meier method and log-rank test were used for survival analysis. A multivariate Cox proportional hazard model, stratified by TNM stage, was used to evaluate prognostic factors. RESULTS Emphysema was present in 110 patients, associated with COPD in 78 (70.9%). In univariate analysis, survival decreased with age>70 years (p=0.01), presence of emphysema (p=0.02), weight loss (p=0.00001), PS≥2 (p=0.00001) and symptomatic treatment (p=0.0001). Multivariate analyses identified emphysema (HR=1.49 (95% CI 1.11-2.01)), PS≥2 (HR=2.12 (95% CI 1.31-3.38)) and treatment: surgery (HR=0.3 (95% CI 0.15-0.56)) and chemotherapy (HR=0.34 (95% CI 0.31-0.57)) as independent prognostic factors. CONCLUSION The presence of emphysema affects the prognostic outcome of patients with non-small cell lung cancer. Emphysema should therefore be considered for prognostic studies on comorbidity.
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Affiliation(s)
- J A Gullón
- Pneumology Service, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
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Gladysheva ES, Malhotra A, Owens RL. Influencing the decline of lung function in COPD: use of pharmacotherapy. Int J Chron Obstruct Pulmon Dis 2010; 5:153-64. [PMID: 20631815 PMCID: PMC2898088 DOI: 10.2147/copd.s4577] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Indexed: 01/22/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common and deadly disease. One of the hallmarks of COPD is an accelerated decline in lung function, as measured by spirometry. Inflammation, oxidative stress and other pathways are hypothesized to be important in this deterioration. Because progressive airflow obstruction is associated with considerable morbidity and mortality, a major goal of COPD treatment has been to slow or prevent the accelerated decline in lung function. Until recently, the only known effective intervention was smoking cessation. However, newly reported large clinical trials have shown that commonly used medications may help slow the rate of lung function decline. The effect of these medications is modest (and thus required such large, expensive trials) and to be of clinical benefit, therapy would likely need to start early in the course of disease and be prolonged. Such a treatment strategy aimed at preservation of lung function would need to be balanced against the side effects and costs of prolonged therapy. A variety of newer classes of medications may help target other pathophysiologically important pathways, and could be used in the future to prevent lung function decline in COPD.
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Affiliation(s)
- Ekaterina S Gladysheva
- Harvard Combined Pulmonary and Critical Care Fellowship, Harvard Medical School, Boston, MA, USA
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Chaturvedi AK, Caporaso NE, Katki HA, Wong HL, Chatterjee N, Pine SR, Chanock SJ, Goedert JJ, Engels EA. C-reactive protein and risk of lung cancer. J Clin Oncol 2010; 28:2719-26. [PMID: 20421535 DOI: 10.1200/jco.2009.27.0454] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chronic inflammation could play a role in lung carcinogenesis, underscoring the potential for lung cancer prevention and screening. We investigated the association of circulating high-sensitivity C-reactive protein (CRP, an inflammation biomarker) and CRP single nucleotide polymorphisms (SNPs) with prospective lung cancer risk. PATIENTS AND METHODS We conducted a nested case-control study of 592 lung cancer patients and 670 controls with available prediagnostic serum and 378 patients and 447 controls with DNA within the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 77,464). Controls were matched to patients on age, sex, entry year, follow-up time, and smoking. We measured CRP levels in baseline serum samples and genotyped five common CRP SNPs. RESULTS Elevated CRP levels were associated with increased lung cancer risk (odds ratio [OR], 1.98; 95% CI, 1.35 to 2.89; P-trend < .001 for fourth quartile [Q4, > or = 5.6 mg/L] v Q1 [< 1.0 mg/L]). The CRP association did not differ significantly by histology, follow-up time, or smoking status, but was most apparent for squamous cell carcinomas (OR, 2.92; 95% CI, 1.30 to 6.54), 2 to 5 years before lung cancer diagnosis (OR, 2.33; 95% CI, 1.24 to 4.39), and among former smokers (OR, 2.48; 95% CI, 1.53 to 4.03) and current smokers (OR, 1.90; 95% CI, 1.06 to 3.41). Although CRP SNPs and haplotypes were associated with CRP levels, they were not associated with lung cancer risk. Ten-year standardized absolute risks of lung cancer were higher with elevated CRP levels among former smokers (Q4: 2.55%; 95% CI, 1.98% to 3.27% v Q1: 1.39%; 95% CI, 1.07% to 1.81%) and current smokers (Q4: 7.37%; 95% CI, 5.81% to 9.33% v Q1: 4.03%; 95% CI, 3.01% to 5.40%). CONCLUSION Elevated CRP levels are associated with subsequently increased lung cancer risk, suggesting an etiologic role for chronic pulmonary inflammation in lung carcinogenesis.
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Affiliation(s)
- Anil K Chaturvedi
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd., Rockville, MD 20852, USA.
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Abstract
U.S. state tobacco control programs have been associated with both temporal increases in smoking cessation rates in young adults and temporal declines in tobacco-related chronic diseases, but mortality from chronic obstructive pulmonary disease apparently has not been studied. Annual percent change (APC) (1990-2005) in age standardized mortality rate at ages 35-64 and 65+ years from this cause was analyzed for California (which started a comprehensive tobacco control program in 1989), the "U.S. exclusive of California," New Jersey and New York (which had relatively high cigarette prices in the 1990s), and a group of six southern tobacco-growing states (which had limited tobacco control efforts and low cigarette prices in the 1990s). Declines in mortality rates from 1990-2005 for age 35-64 were larger and statistically significant in California (annual % change -1.6%) and New Jersey-New York (annual % change -1.8%), while declines the "U.S. exclusive of California" (annual % change -0.5%) and in six southern tobacco-growing states (annual % change -0.3%). Declines in mortality at age 65+ years were small or nonexistent. The geographic differences in mortality for age 35-64 years after 1990 were not a continuation of earlier trends (in 1980-89), and may be related to differences in tobacco control efforts. This suggests that states should increase their tobacco-control efforts, to reduce chronic obstructive pulmonary disease mortality in the entire U.S.
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Salpeter SR. Do inhaled anticholinergics increase or decrease the risk of major cardiovascular events?: a synthesis of the available evidence. Drugs 2010; 69:2025-33. [PMID: 19791824 DOI: 10.2165/11318580-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There has been recent uncertainty about whether the inhaled anticholinergic agents ipratropium bromide and tiotropium bromide increase or decrease cardiovascular risk in the treatment of patients with chronic obstructive pulmonary disease (COPD). This article synthesizes the available data in order to understand the controversy. COPD is a common cause of hospitalizations and is a rapidly increasing cause of mortality worldwide. Despite the heavy burden of COPD-related illness, the leading cause of hospitalization in COPD patients is cardiovascular disease. This link between COPD and cardiovascular disease is in part due to the fact that both diseases share common risk factors, such as tobacco smoking and advanced age. It is also hypothesized that systemic inflammation in COPD increases the risk for cardiac events such as myocardial infarction. Inhaled anticholinergics reduce COPD-related hospitalizations and respiratory deaths compared with placebo, and tiotropium bromide is more effective than ipratropium bromide. In randomized trials, patients receiving tiotropium bromide have lower discontinuation rates than those receiving placebo and, therefore, contribute more person-years to the analyses. In a recent large 4-year tiotropium bromide trial, the proportion of patients who died was similar in the tiotropium bromide and placebo groups, whereas the death rate per person-years was lower with tiotropium bromide, indicating longer overall survival. There has been conflicting evidence concerning cardiovascular risk associated with inhaled anticholinergics. One meta-analysis found that the risk for major cardiovascular events was higher with anticholinergics compared with placebo or active comparator controls, whereas two subsequent meta-analyses that included new trial data found no difference in risk. In a recent pooled safety analysis, when incidence rates of events over time were evaluated, tiotropium bromide was associated with a lower rate of major cardiovascular events and cardiovascular deaths compared with placebo. This risk reduction was mainly because of a reduction in serious cardiac events such as myocardial infarction and congestive heart failure. In conclusion, inhaled anticholinergics, especially tiotropium bromide, reduce COPD-related hospitalizations and deaths, and may improve total survival over time. Many COPD patients have concomitant cardiovascular disease processes. Thus, trials may observe more cardiovascular events associated with anticholinergics than with placebo, but this differential is eliminated when evaluating the rate of events per person-years of exposure. New evidence indicates that tiotropium bromide may actually reduce the incidence of cardiovascular events and deaths over time. It is possible that the reduction in respiratory morbidity could improve functional status and reduce adverse cardiac outcomes over time. Further studies are needed to address this important issue.
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Affiliation(s)
- Shelley R Salpeter
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
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Bibliography. Current world literature. Curr Opin Pulm Med 2009; 15:170-7. [PMID: 19225311 DOI: 10.1097/mcp.0b013e3283276f69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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Ngan DA, Vickerman SV, Granville DJ, Man SFP, Sin DD. The possible role of granzyme B in the pathogenesis of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2009; 3:113-29. [PMID: 19638369 DOI: 10.1177/1753465809341965] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent inflammatory lung condition characterized by airways disease and emphysema, and the precise mechanism of pathogenesis is poorly understood. The consistent features of COPD include protease-antiprotease imbalance, inflammation and accelerated aging caused by apoptosis or senescence. One family of molecules involved in all of these processes is the granzymes, serine proteases with the best-known member being granzyme B (GzmB). The majority of GzmB is released unidirectionally towards target cells, but GzmB can also be released nonspecifically and escape into the extracellular environment. GzmB is capable of cleaving extracellular matrix (ECM) proteins in vitro, and the accumulation of GzmB in the extracellular milieu during chronic inflammation in COPD could contribute to ECM degradation and remodelling and, consequently, the emphysematous phenotype in the lung. Preliminary studies suggest that increased GzmB expression is associated with increased COPD severity, and this may represent a promising new target for drug and biomarker discovery in COPD. In this paper, we review the potential pathogenic contributions of GzmB to the pathogenesis of COPD.
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Affiliation(s)
- David A Ngan
- James Hogg Research Laboratories, Providence Heart + Lung Institute at St. Paul's Hospital and Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Fruchter O, Yigla M. Cardiac Troponin-I Predicts Long-Term Mortality in Chronic Obstructive Pulmonary Disease. COPD 2009; 6:155-61. [DOI: 10.1080/15412550902902620] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gadgil A, Duncan SR. Role of T-lymphocytes and pro-inflammatory mediators in the pathogenesis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2009; 3:531-41. [PMID: 19281072 PMCID: PMC2650590 DOI: 10.2147/copd.s1759] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the US and a major worldwide healthcare problem. The pathophysiologic mechanisms that drive development and progression of this disease are complex and only poorly understood. While tobacco smoking is the primary risk factor, other disease processes also appear to play a role. Components of the innate immune system (eg, macrophages and neutrophils) have long been believed to be important in the development of COPD. More recent evidence also suggests involvement of the adaptive immune system in pathogenesis of this disease. Here we will review the literature supporting the participation of T-cells in the development of COPD, and comment on the potential antigenic stimuli that may account for these responses. We will further explore the prospective contributions of T-cell derived mediators that could contribute to the inflammation, alveolar wall destruction, and small airway fibrosis of advanced COPD. A better understanding of these complex immune processes will lead to new insights that could result in improved preventative and/or treatment strategies.
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Affiliation(s)
- Aneal Gadgil
- Division of Pulmonary,Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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El cáncer de pulmón y la enfermedad pulmonar obstructiva crónica estrechan relaciones. Med Clin (Barc) 2008; 131:775-6. [DOI: 10.1016/s0025-7753(08)75503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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