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Trudzinski FC, Jörres RA, Alter P, Watz H, Vogelmeier CF, Kauczor HU, Thangamani S, Debic M, Welte T, Behr J, Kahnert K, Bals R, Herr C, Heußel CP, Biederer J, von Stackelberg O, Fähndrich S, Wouters EFM, Waschki B, Rabe KF, Herth FJF, Palm V. Midregional Proatrial Natriuretic Peptide (MRproANP) is associated with vertebral fractures and low bone density in patients with chronic obstructive pulmonary disease (COPD). Respir Res 2024; 25:274. [PMID: 39003487 PMCID: PMC11245771 DOI: 10.1186/s12931-024-02902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD. RESEARCH QUESTION We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD. METHODS Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses. RESULTS Among 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density. INTERPRETATION MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization. TRIAL REGISTRATION ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.
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Affiliation(s)
- Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine), German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik University of Heidelberg, Röntgenstrasse 1, 69126, Heidelberg, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, German Center for Lung Research (DZL), LMU University Hospital, Ludwig-Maximilians-University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Subasini Thangamani
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Manuel Debic
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, CPC Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, CPC Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Christian Herr
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Claus Peter Heußel
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, Kiel, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Sebastian Fähndrich
- Department of Pneumology, University Medical Centre Freiburg, Freiburg, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Medical Faculty, Sigmund Freud University, Vienna, Austria
- Department of Internal Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Benjamin Waschki
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Pulmonary Research Institute, Woehrendamm 80, 22927, Grosshansdorf, Germany
- Department of Pneumology, Itzehoe Hospital, Itzehoe, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Pulmonary Research Institute, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine), German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik University of Heidelberg, Röntgenstrasse 1, 69126, Heidelberg, Germany
| | - Viktoria Palm
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
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2
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Stoleriu MG, Pienn M, Joerres RA, Alter P, Fero T, Urschler M, Kovacs G, Olschewski H, Kauczor HU, Wielpütz M, Jobst B, Welte T, Behr J, Trudzinski FC, Bals R, Watz H, Vogelmeier CF, Biederer J, Kahnert K. Expiratory Venous Volume and Arterial Tortuosity are Associated with Disease Severity and Mortality Risk in Patients with COPD: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2024; 19:1515-1529. [PMID: 38974817 PMCID: PMC11227296 DOI: 10.2147/copd.s458905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose The aim of this study was to evaluate the association between computed tomography (CT) quantitative pulmonary vessel morphology and lung function, disease severity, and mortality risk in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods Participants of the prospective nationwide COSYCONET cohort study with paired inspiratory-expiratory CT were included. Fully automatic software, developed in-house, segmented arterial and venous pulmonary vessels and quantified volume and tortuosity on inspiratory and expiratory scans. The association between vessel volume normalised to lung volume and tortuosity versus lung function (forced expiratory volume in 1 sec [FEV1]), air trapping (residual volume to total lung capacity ratio [RV/TLC]), transfer factor for carbon monoxide (TLCO), disease severity in terms of Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D, and mortality were analysed by linear, logistic or Cox proportional hazard regression. Results Complete data were available from 138 patients (39% female, mean age 65 years). FEV1, RV/TLC and TLCO, all as % predicted, were significantly (p < 0.05 each) associated with expiratory vessel characteristics, predominantly venous volume and arterial tortuosity. Associations with inspiratory vessel characteristics were absent or negligible. The patterns were similar for relationships between GOLD D and mortality with vessel characteristics. Expiratory venous volume was an independent predictor of mortality, in addition to FEV1. Conclusion By using automated software in patients with COPD, clinically relevant information on pulmonary vasculature can be extracted from expiratory CT scans (although not inspiratory scans); in particular, expiratory pulmonary venous volume predicted mortality. Trial Registration NCT01245933.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Division for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center; Munich-Gauting, Gauting, 82131, Germany
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive; Helmholtz Center Munich; Member of the German Lung Research Center (DZL), Munich, 81377, Germany
| | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rudolf A Joerres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Munich, 80336, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, 35033, Germany
| | - Tamas Fero
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Urschler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- University Clinic for Internal Medicine, Medical University of Graz, Division of Pulmonology, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- University Clinic for Internal Medicine, Medical University of Graz, Division of Pulmonology, Graz, Austria
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Mark Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Bertram Jobst
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Member of the German Center of Lung Research, Hannover School of Medicine, Hannover, Germany
| | - Jürgen Behr
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive; Helmholtz Center Munich; Member of the German Lung Research Center (DZL), Munich, 81377, Germany
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C Trudzinski
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Respiratory Critical Care Medicine, Saarland University, Homburg, 66421, Germany
- Helmholtz Institute for Pharmaceutical Research, Saarbrücken, 66123, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Großhansdorf, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, 35033, Germany
| | - Jürgen Biederer
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
- Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, Kiel, Germany
- University of Latvia, Faculty of Medicine, Riga, LV-1586, Latvia
| | - Kathrin Kahnert
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive; Helmholtz Center Munich; Member of the German Lung Research Center (DZL), Munich, 81377, Germany
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- MediCenterGermering, Germering, Germany
| | - On behalf of the COSYCONET Study Group
- Division for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center; Munich-Gauting, Gauting, 82131, Germany
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive; Helmholtz Center Munich; Member of the German Lung Research Center (DZL), Munich, 81377, Germany
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Munich, 80336, Germany
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, 35033, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- University Clinic for Internal Medicine, Medical University of Graz, Division of Pulmonology, Graz, Austria
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
- Department of Respiratory Medicine and Infectious Disease, Member of the German Center of Lung Research, Hannover School of Medicine, Hannover, Germany
- Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Department of Internal Medicine V-Pulmonology, Allergology and Respiratory Critical Care Medicine, Saarland University, Homburg, 66421, Germany
- Helmholtz Institute for Pharmaceutical Research, Saarbrücken, 66123, Germany
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Großhansdorf, Germany
- Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, Kiel, Germany
- University of Latvia, Faculty of Medicine, Riga, LV-1586, Latvia
- MediCenterGermering, Germering, Germany
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3
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Fabbri LM, Celli BR, Agustí A, Criner GJ, Dransfield MT, Divo M, Krishnan JK, Lahousse L, Montes de Oca M, Salvi SS, Stolz D, Vanfleteren LEGW, Vogelmeier CF. COPD and multimorbidity: recognising and addressing a syndemic occurrence. THE LANCET. RESPIRATORY MEDICINE 2023; 11:1020-1034. [PMID: 37696283 DOI: 10.1016/s2213-2600(23)00261-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 09/13/2023]
Abstract
Most patients with chronic obstructive pulmonary disease (COPD) have at least one additional, clinically relevant chronic disease. Those with the most severe airflow obstruction will die from respiratory failure, but most patients with COPD die from non-respiratory disorders, particularly cardiovascular diseases and cancer. As many chronic diseases have shared risk factors (eg, ageing, smoking, pollution, inactivity, and poverty), we argue that a shift from the current paradigm in which COPD is considered as a single disease with comorbidities, to one in which COPD is considered as part of a multimorbid state-with co-occurring diseases potentially sharing pathobiological mechanisms-is needed to advance disease prevention, diagnosis, and management. The term syndemics is used to describe the co-occurrence of diseases with shared mechanisms and risk factors, a novel concept that we propose helps to explain the clustering of certain morbidities in patients diagnosed with COPD. A syndemics approach to understanding COPD could have important clinical implications, in which the complex disease presentations in these patients are addressed through proactive diagnosis, assessment of severity, and integrated management of the COPD multimorbid state, with a patient-centred rather than a single-disease approach.
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Affiliation(s)
- Leonardo M Fabbri
- Section of Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alvar Agustí
- Cátedra Salud Respiratoria, Universitat de Barcelona, Barcelona, Spain; Institut Respiratori, Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédicas August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Spain
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Miguel Divo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Maria Montes de Oca
- School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; Hospital Centro Medico de Caracas, Caracas, Venezuela
| | - Sundeep S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India; School of Health Sciences, Symbiosis International Deemed University, Pune, India
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University of Marburg, Member of the German Centre for Lung Research, Marburg, Germany.
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4
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Kahnert K, A. Jörres R, Behr J, Welte T. The Diagnosis and Treatment of COPD and Its Comorbidities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:434-444. [PMID: 36794439 PMCID: PMC10478768 DOI: 10.3238/arztebl.m2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/12/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third most common cause of death around the world. The affected patients suffer not only from impaired lung function, but also from a wide variety of comorbidities. Their cardiac comorbidities, in particular, lead to increased mortality. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, including guidelines from Germany and abroad. RESULTS The usual diagnostic criteria for COPD are a post-bronchodilator FEV1/FVC quotient below the fixed threshold of 0.7, or, preferably, below the lower limit of normal (LLN) according to the GLI reference values for the avoidance of over- and underdiagnosis. The overall prognosis is markedly affected by comorbidities of the lung itself and those that involve other organs; in particular, many persons with COPD die of heart disease. The potential presence of heart disease must be borne in mind in the evaluation of patients with COPD, as lung disease can impair the detection of heart disease. CONCLUSION As patients with COPD are often multimorbid, the early diagnosis and adequate treatment not only of their lung disease, but also of their extrapulmonary comorbidities are very important. Well-established diagnostic instruments and well-tested treatments are available and are described in detail in the guidelines concerning the comorbidities. Preliminary observations suggest that more attention should be paid to the potential positive effects of treating comorbidities on the lung disease itself, and vice versa.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Rudolf A. Jörres
- Institute of Occupational, Social and Environmental Medicine,Ludwig Maximilians University LMU, Comprehensive Pneumology Center Munich, Munich
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center of Lung Research (DZL), Hannover
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5
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Kahnert K, Fischer C, Alter P, Trudzinski F, Welte T, Behr J, Herth F, Kauczor HU, Bals R, Watz H, Rabe K, Söhler S, Kokot I, Vogelmeier C, Jörres R. [What have we learned from the German COPD cohort COSYCONET and where do we go from here?]. Pneumologie 2022; 77:81-93. [PMID: 36526266 PMCID: PMC9931494 DOI: 10.1055/a-1966-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.
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Affiliation(s)
- Kathrin Kahnert
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland,Korrespondenzadresse PD Dr. med. Kathrin Kahnert Klinikum der Universität München LMU, Medizinische Klinik VZiemssenstr. 180336 MünchenDeutschland
| | - Carolina Fischer
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Peter Alter
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Franziska Trudzinski
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Tobias Welte
- 9177Klinik für Pneumologie, Medizinische Hochschule Hannover, Member of the German Center of Lung Research (DZL), Hannover, Deutschland
| | - Jürgen Behr
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland
| | - Felix Herth
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- 27178Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Deutschland
| | - Robert Bals
- 39072Innere Medizin V – Pulmonologie, Allergologie, Beatmungs-und Umweltmedizin, Universitätsklinikum des Saarlandes, Associated member of the Germen Center of Lung Research (DZL), Homburg, Deutschland,9377Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Deutschland
| | - Henrik Watz
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland
| | - Klaus Rabe
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland,98594Medizinische Fakultät, Christian-Albrechts Universität zu Kiel, Kiel, Deutschland
| | - Sandra Söhler
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Inge Kokot
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Claus Vogelmeier
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Rudolf Jörres
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
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6
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Park SS, Perez Perez JL, Perez Gandara B, Agudelo CW, Rodriguez Ortega R, Ahmed H, Garcia-Arcos I, McCarthy C, Geraghty P. Mechanisms Linking COPD to Type 1 and 2 Diabetes Mellitus: Is There a Relationship between Diabetes and COPD? Medicina (B Aires) 2022; 58:medicina58081030. [PMID: 36013497 PMCID: PMC9415273 DOI: 10.3390/medicina58081030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients frequently suffer from multiple comorbidities, resulting in poor outcomes for these patients. Diabetes is observed at a higher frequency in COPD patients than in the general population. Both type 1 and 2 diabetes mellitus are associated with pulmonary complications, and similar therapeutic strategies are proposed to treat these conditions. Epidemiological studies and disease models have increased our knowledge of these clinical associations. Several recent genome-wide association studies have identified positive genetic correlations between lung function and obesity, possibly due to alterations in genes linked to cell proliferation; embryo, skeletal, and tissue development; and regulation of gene expression. These studies suggest that genetic predisposition, in addition to weight gain, can influence lung function. Cigarette smoke exposure can also influence the differential methylation of CpG sites in genes linked to diabetes and COPD, and smoke-related single nucleotide polymorphisms are associated with resting heart rate and coronary artery disease. Despite the vast literature on clinical disease association, little direct mechanistic evidence is currently available demonstrating that either disease influences the progression of the other, but common pharmacological approaches could slow the progression of these diseases. Here, we review the clinical and scientific literature to discuss whether mechanisms beyond preexisting conditions, lifestyle, and weight gain contribute to the development of COPD associated with diabetes. Specifically, we outline environmental and genetic confounders linked with these diseases.
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Affiliation(s)
- Sangmi S. Park
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Jessica L. Perez Perez
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Brais Perez Gandara
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Christina W. Agudelo
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Romy Rodriguez Ortega
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Huma Ahmed
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Itsaso Garcia-Arcos
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
| | - Cormac McCarthy
- University College Dublin School of Medicine, Education and Research Centre, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA; (S.S.P.); (J.L.P.P.); (B.P.G.); (C.W.A.); (R.R.O.); (H.A.); (I.G.-A.)
- Correspondence: ; Tel.: +1-718-270-3141
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Sun J, Liu Q, He H, Jiang L, Lee KO, Li D, Ma J. Metformin treatment is associated with an increase in bone mineral density in type 2 diabetes mellitus patients in China: a retrospective single center study. DIABETES & METABOLISM 2022; 48:101350. [PMID: 35452818 DOI: 10.1016/j.diabet.2022.101350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022]
Abstract
AIMS - To investigate the association between metformin and bone mineral density (BMD) in a large cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS - A total of 11,458 T2DM patients aged ≥ 40 years were included. Information on demographic, anthropometric and clinical characteristics was collected from medical records. BMD at lumbar spine (LS), femoral neck (FN), and total hip(TH) was assessed by dual-energy X-ray absorptiometry. RESULTS - Overall prevalence of osteopenia and osteoporosis was 37.4% and 10.3%, and was lower in patients on metformin (34.6% vs 38.3% and 7.1% vs 11.3%, both P < 0.001). Patients who had a lower BMI, older age, and lower estimated glomerular filtration rate (eGFR), had more osteoporosis, lower BMD (osteoporosis or osteopenia), and a lower T-score at LS, FN and TH. Metformin use and male sex was associated with a higher BMD. Metformin treatment was also independently associated with higher T-score at LS, FN and TH (β values of 0.120, 0.082 and 0.108; all P < 0.001), and lower odds ratio of osteoporosis (OR = 0.779, 95%CI: 0.648-0.937, P = 0.008) or low BMD (OR = 0.834, 95%CI: 0.752 - 0.925, P = 0.001). However, when analyzed by sex, this association of a lower odds ratio for osteoporosis with metformin was only significant in women (OR= 0.775, 95% CI: 0.633-0.948; P = 0.013). CONCLUSIONS - Metformin treatment was associated with a higher T-score and a lower odds ratio of osteopenia and osteoporosis, especially in the female population, independent of age, BMI, and eGFR.
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Affiliation(s)
- JunWei Sun
- Department of endocrinology, Jiangyin Fourth People's Hospital, Jiangyin, China
| | - Qi Liu
- Department of endocrinology, Yining People's Hospital, lli Kazakh Autonomous Prefecture, China
| | - Huan He
- Department of endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lanlan Jiang
- Department of endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kok Onn Lee
- Kok Onn Lee, Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Dongmei Li
- Department of endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jianhua Ma
- Department of endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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