Journal Information
Vol. 45. Issue S4.
EPOC y comorbilidad: una visión global
Pages 18-23 (March 2009)
Share
Share
Download PDF
More article options
Vol. 45. Issue S4.
EPOC y comorbilidad: una visión global
Pages 18-23 (March 2009)
Full text access
Comorbilidad cardiovascular en la EPOC
Cardiovascular comorbidity in COPD
Visits
10036
Juan José Soler Cataluña
Corresponding author
jjsoler@telefonica.net

Autor para correspondencia.
, Miguel Ángel Martínez García
Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumen

La presencia de alteraciones cardiovasculares entre los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) supera los límites de la casualidad. El tabaquismo, un factor de riesgo común a ambas entidades, podría explicar, en parte, la fuerza de la asociación; sin embargo, hay indicios para suponer que otros determinantes, como la inflamación sistémica, el estrés oxidativo, la hipoxemia, la disfunción endotelial e incluso el propio envejecimiento, podrían estar también implicados. En los pacientes donde coinciden ambas enfermedades, las consecuencias finales son manifiestamente peores. La enfermedad cardiovascular (ECV) contribuye a la hospitalización de los pacientes con EPOC y también a su mortalidad. Aproximadamente, uno de cada 4 pacientes con EPOC fallece de causa cardiovascular. En sentido contrario, la exacerbación de la EPOC también contribuye a un número mayor de episodios cardiovasculares, e incluso se ha detectado un incremento de la mortalidad entre los pacientes con ECV que presentan EPOC frente a controles no EPOC. Estos condicionantes subrayan la necesidad de desarrollar una visión integral capaz de identificar de forma temprana al candidato y emplear alternativas terapéuticas adecuadas. Se ha sugerido que los vasodilatadores, estatinas o bloqueadores beta pueden mejorar la morbimortalidad del paciente con EPOC, quizá por maximizar el control en la ECV subyacente. No obstante, también se apunta que el potencial antiinflamatorio de las estatinas podría ser de interés. Los corticoides inhalados, e incluso algunos broncodilatadores, también pueden disminuir la morbilidad cardiovascular. Estos datos son observacionales y deben enjuiciarse con precaución. No obstante, son suficientemente provocadores para justificar el enorme interés que suscita la interacción entre 2 de las enfermedades crónicas más prevalentes del mundo occidental, la EPOC y la ECV.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Enfermedad cardiovascular
Comorbilidad
Abstract

The presence of cardiovascular alterations in patients with chronic obstructive pulmonary disease (COPD) is no coincidence. Smoking, a risk factor for both entities, could partly explain the strength of the association; however, there are data that suggest that other determining factors such as systemic inflammation, oxidative stress, hypoxemia, endothelial dysfunction and even aging could also be involved. Prognosis is worse in patients with both entities. Cardiovascular disease (CVD) contributes to hospitalization in patients with COPD and to mortality.

Approximately one out of every four patients with COPD dies from cardiovascular causes. Equally, COPD exacerbation also leads to a greater number of cardiovascular events and an increase in mortality has even been found among patients with CVD and COPD compared with controls without COPD. These determining factors underline the need to develop a comprehensive view for the early detection of at-risk individuals and use of appropriate therapeutic measures.

Vasodilators, statins and beta-blockers may improve morbidity and mortality in patients with COPD, possibly because these drugs maximize control of the underlying CVD. Nevertheless, the antiinflammatory potential of statins could be of interest. Inhaled corticosteroids and even some bronchodilators could also decrease cardiovascular morbidity. These data are from observational studies and should be interpreted with caution but are nevertheless sufficiently interesting to warrant the enormous interest aroused by the interaction between the two most prevalent chronic diseases in the western world, COPD and CVD.

Key words:
Chronic obstructive pulmonary disease
Cardiovascular disease
Comorbidity
Full text is only aviable in PDF
Bibliografía
[1.]
D.D. Sin, L. Wu, S.F. Man.
The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic reviewe of the literature.
Chest, 127 (2005), pp. 1952-1959
[2.]
P.D. Sorile, W.B. Kannel, G. O’Connor.
Mortality associated with respiratory function and symptoms in advance age. The Framingham Study.
Am Rev Respir Dis, 140 (1989), pp. 379-384
[3.]
T. Truelsen, E. Prescott, P. Lange, P. Schnohr, G. Boysen.
Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study.
Int J Epidemiol, 30 (2001), pp. 145-151
[4.]
D.J. Hole, G.C. Watt, G. Daved-Smith, C.L. Hart, C.R. Gillis, V.M. Harwthorne.
Impaired lung function and mortality risk in men and women: findings from the Refrew and Paisley prospective population study.
BMJ, 313 (1996), pp. 711-715
[5.]
N.R. Anthonisen, J.E. Connett, P.L. Enright, J. Manfreda.
Hospitalizations and mortality in Lung Health Study.
Am J Respir Crit Care Med, 166 (2002), pp. 333-339
[6.]
G. Engstrom, B. Hedbland, L. Janzon, S. Valind.
Respiratory decline in smokers and ex-smolkers-an independent risk factor for cardiovascular disease and death.
J Cardiovasc Risk, 7 (2000), pp. 267-272
[7.]
A. Hozawa, J.L. Billings, E. Shahar, T. Ohira, W.E.D. Rosamond, A.R. Folsom.
Lung function and ischemic stroke incidence: the Atherosclerosis Risk in Commnities Study.
Chest, 130 (2006), pp. 1642-1649
[8.]
M. Miravitlles, J.B. Soriano, L. Muñoz, F. García-Rio, G. Sánchez, M. Sarmiento, et al.
COPD prevalence in Spain 2007 (EPI-SCAN study results).
[9.]
J.M. Baeza Díez, J.L. Del Val García, J. Tomás Pelegrina, J.L. Martínez Martínez, R. Martín Peñacoba, I. González Tejón, et al.
Epidemiología de las enfermedades cardiovasculares y factores de riesgo en atención primaria.
Rev Esp Cardiol, 58 (2005), pp. 367-373
[10.]
J.B. Soriano, G.T. Visick, H. Muellerova, N. Payvandi, A.L. Hansell.
Patterns of comorbidities in newly diagnosed COPD and asthma in primary care.
Chest, 128 (2005), pp. 2099-2107
[11.]
D.W. Mapel, J.S. Hurley, F.J. Frost, H.V. Petersen, M.A. Picchi, D.B. Coultas.
Health care utilization in chronic obstructive pulmonary disease. A case-control study in a health maintenance organization.
Arch Intern Med, 160 (2000), pp. 2653-2658
[12.]
A.K. Johnston, D.M. Mannino, G.W. Hagan, K.J. Davis, V.A. Kiri.
Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort.
Thorax, 63 (2008), pp. 599-605
[13.]
D.D. Sin, P.S.F. Man.
Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease.
Circulation, 107 (2003), pp. 1514-1519
[14.]
H. Iwamoto, A. Yokoyama, Y. Kitahara, N. Ishihawa, Y. Haruta, K. Yamene, et al.
Airflow limitation in smokers is associated with sublcinical atherosclerosis.
Am J Respir Crit Care Med, 179 (2009), pp. 35-40
[15.]
P. Libby, P.M. Ridker, A. Maseri.
Inflammation and atherosclerosis.
Circulation, 105 (2002), pp. 1135-1143
[16.]
E.F. Woouters.
Local and systemic inflammation in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 2 (2005), pp. 26-33
[17.]
W. Koening, H. Lowel, J. Baumert, C. Meisinger.
C-reactive protein modulates risk prediction based on the Framingham Score: implications for future risk assessment: results from a large cohort study in the southern Germnay.
Circulation, 109 (2004), pp. 1349-1353
[18.]
R. Arroyo-Espliguero, P. Avanzas, J. Cosin-Sales, G. Aldama, C. Pizzi, J.C. Kaski.
C-reactive protein elevation and disease activity in patients with coronary heart disease.
Eur Heart J, 25 (2004), pp. 401-408
[19.]
J.L. Izquierdo Alonso, R. Arroyo-Espliguero.
EPOC y riesgo cardiovascular.
Arch Bronconeumol, 41 (2005), pp. 410-412
[20.]
W.Q. Gan, S.F.P. Man, A. Senthilselvan, D.D. Sin.
Association between chronic obstructive pulmonary disease and systemic inflammation: a systemic review and a metaanalysis.
Thorax, 59 (2004), pp. 574-580
[21.]
F. Bonomini, S. Tengattini, A. Fabiano, R. Bianchi, R. Rezzani.
Atherosclerosis and oxidative stress.
Histol Histopathol, 23 (2008), pp. 381-390
[22.]
W. MacNee, J. Maclay, D. McAllister.
Cardiovascular injury and repair in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 5 (2008), pp. 824-833
[23.]
F. Villar Álvarez, J. De Miguel Diez, J.L. Álvarez-Sala.
EPOC y acontecimientos cardiovasculares.
Arch Bronconeumol, 44 (2008), pp. 152-159
[24.]
M. Zureik, A. Benetos, C. Neukirch, D. Courbon, K. Bean, F. Thomas, et al.
Reduced pulmonary function is associated with central arterial stiffness in men.
Am J Respir Crit Care Med, 164 (2001), pp. 2181-2185
[25.]
R. Sabit, C.E. Bolton, P.H. Edwards, R.J. Pettit, W.D. Evans, C.M. McEniery, et al.
Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 175 (2007), pp. 1259-1265
[26.]
N.L. Mills, J.J. Miller, A. Anand, S.D. Robinson, G.A. Frazer, D. Anderson, et al.
Increased arterial stiffness in patients with chronic obstructive pulmomary disease: a mechanism for increased cardiovascular risk.
Thorax, 63 (2008), pp. 306-311
[27.]
R.G. Barr, S. Mesia-Vela, J.H.M. Austin, R.C. Basner, B.M. Keller, A.P. Reeves, et al.
Impaired flow-mediated dilation is associated with low pulmonary function and emphysema in exsmokers: the Emphysema and Cancer Action Project (EMCAP) Study.
Am J Respir Crit Care Med, 176 (2007), pp. 1200-1207
[28.]
H. Kanazawa, K. Asai, K. Hirata, J. Yoshikawa.
Possible effects of vascular endothelial growth factor in the pathogenesis of chronic obstructive pulmonary disease.
Am J Med, 114 (2003), pp. 354-358
[29.]
P. Eickhoff, A. Valipour, D. Kiss, M. Schreder, L. Cekici, K. Geyer, et al.
Determinants of systemic vascular function in patients with stable chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 178 (2008), pp. 1211-1218
[30.]
S.R. Chan, E.H. Blackburn.
Telomres and telomerase.
Philos Trans R Soc Lond B Biol Sci, 359 (2004), pp. 109-121
[31.]
M. Morla, X. Busquets, J. Pons, J. Sauleda, W. MacNee, A.G. Agusti.
Telomere shortening in smokers with and without COPD.
Eur Respir J, 27 (2006), pp. 525-528
[32.]
T. Tsuji, K. Aoshiba, A. Nagai.
Alveolar cell senescence in patients with pulmonary emphysema.
Am J Respir Crit Care Med, 174 (2006), pp. 886-893
[33.]
H. Aviv, M.Y. Khan, J. Skurnick, K. Okuda, M. Kimura, J. Garderne, et al.
Age dependent aneuploidy and telomere length of human vascular endothelium.
Atherosclerosis, 159 (2001), pp. 281-287
[34.]
N.R. Anthonisen, J.E. Connett, J.P. Kiley, M.D. Altose, W.C. Bailey, A.S. Buist, et al.
Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study.
JAMA, 272 (1994), pp. 1497-1505
[35.]
D. Tashkin, M. Decramer, D. Mannino, I. Leimer, S. Kesten.
Elevated incidente of serious non-respiratory adverse event following COPD exacerbations in clinical trials.
Am J Respir Crit Care, 177 (2008), pp. A132
[36.]
F. Abroug, L. Quanes-Besbes, N. Nciri, N. Sellami, F. Addad, K. Ben Hamda, et al.
Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disaase. Diagnostic performance of cardiac biomarkers.
Am J Respir Crit Care Med, 174 (2006), pp. 990-996
[37.]
D. Stolz, T. Breidthardt, M. Christ-Crain, R. Bingisser, D. Miedinger, J. Leuppi, et al.
Use of B-type natriuretic peptide in the risk stratification of acute exacerbation of COPD.
Chest, 133 (2008), pp. 1088-1094
[38.]
S. Korff, H.A. Katus, E. Giannitsis.
Differential diagnosis of elevated troponins.
Heart, 92 (2006), pp. 987-993
[39.]
G.C. Donaldson, J.R. Hurst, C.J. Smith, R.B. Hubbard, J.A. Wedzicha.
Exacerbations and the risk of myocardial infarction in chronic obstructive pulmonary disease.
Am J Respir Crit Care, 177 (2008), pp. A783
[40.]
J.S. Berger, T.A. Sanborn, W. Sherman, D.L. Brown.
Effect of chronic obstructive pulmonary disease on survival of patients with coronary heart disease having percutaneous coronary intervention.
Am J Cardiol, 94 (2004), pp. 649-651
[41.]
D.D. Sin, N.R. Anthonisen, J.B. Soriano, A.G. Agustí.
Mortality in COPD: role of comorbidities.
Eur Respir J, 28 (2006), pp. 1245-1257
[42.]
J.B. Soriano, J.L. Izquierdo Alonso.
EPOC en la vida y en la muerte.
Arch Bronconeumol, 42 (2006), pp. 421-422
[43.]
L.P. McGarvey, M. John, J.E. Anderson, M. Zvarich, R. Wise.
Ascertainment of causespecific mortality in COPD: operations of the TORCH clinical endpoint committee.
Thorax, 62 (2007), pp. 411-415
[44.]
N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett, et al.
The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.
Ann Intern Med, 142 (2005), pp. 233-239
[45.]
J.A. Wedzicha, P.M.A. Calverley, T.A. Seemungl, G. Hagan, Z. Ansari, A. Stockley, et al.
The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.
Am J Respir Crit Care Med, 177 (2008), pp. 19-26
[46.]
R.A. Antonelli-Incalzi, L. Fuso, M. De Rosa, E. Rapiti, B. Nardecchia, R. Pistelli.
Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease.
Eur Respir J, 10 (1997), pp. 2794-2800
[47.]
H. Gunen, S.S. Hacievligyagil, F. Kosar, L.C. Mutlu, G. Gulbas, E. Pehlivan, et al.
Factors affecting survival of hospitalised patients with COPD.
Eur Respir J, 26 (2005), pp. 234-241
[48.]
G.J. Mancini, M. Etminan, B. Zhang, L.E. Levesque, M. FitzGerald, J.M. Brophy.
Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptors blockers in patients with chronic obstructive pulmonary disease.
J Am Coll Cardiol, 47 (2006), pp. 2554-2560
[49.]
V. Søyseth, P.H. Brekke, P. Smith, T. Omland.
Statin use is associated with reduced mortality in COPD.
Eur Respir J, 29 (2007), pp. 279-283
[50.]
S.E. Alexeff, A.A. Litonjua, D. Sparrrow, P.S. Vokonas, J. Schwart.
Statin use reduces decline in lung function: VA normative aging study.
Am J Respir Crit Care Med, 176 (2007), pp. 742-747
[51.]
M.T. Dransfield, S.M. Rowe, J.E. Johnson, W.C. Bailey, L.B. Gerald.
Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of copd.
Thorax, 63 (2008), pp. 301-305
[52.]
Y.R. Van Gestel, S.E. Hoeks, D.D. Sin, G.M. Welten, O. Schouten, H.J. Witteveen, et al.
The impact of cardioselective b-blockers on mortality in patients with COPD and atherosclerosis.
Am J Respir Crit Care Med, 178 (2008), pp. 695-700
[53.]
D.D. Sin, P. Lacy, E. York, S.F. Man.
Effects of fluticasone on systemic markers of inflammation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 170 (2004), pp. 760-765
[54.]
L. Huiart, P. Ernst, X. Panouil, S. Suissa.
Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD.
Eur Respir J, 25 (2005), pp. 634-639
[55.]
C.G. Lofdahl, D.S. Postma, N.B. Pride, J. Boe, A. Thoren.
Possible protection by inhaled budesonide against ischaemic cardiac events in mild COPD.
Eur Respir J, 29 (2007), pp. 1115-1119
[56.]
D.D. Sin.
The effects of fluticasone with or without salmeterol on systemic biomarkers of inflammation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 177 (2008), pp. 1207-1214
[57.]
D.P. Tashkin, B. Celli, S. Senn, D. Burkhart, S. Kesten, S. Mejoge, et al.
A 4-year trial of tiotropium in chronic obstructive pulmonary disease.
New Engl J Med, 359 (2008), pp. 1543-1554
[58.]
C. Vassaux, L. Torre-Bouscoulet, S. Zeineldine, F. Cortopassi, H. Paz-Díaz, B. Cellí, et al.
Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD.
Eur Respir J, 32 (2008), pp. 1275-1282
[59.]
K. Jörgensen, E. Houltz, U. Westfelt, F. Nilson, H. Scherstén, S.E. Ricksten.
Effects of lung volumen reduction surgery on left ventricular diastolic filling and dimensions in patients with severe emphysema.
Chest, 124 (2003), pp. 1863-1870
Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?