Journal Information
Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 18-22 (June 2010)
Share
Share
Download PDF
More article options
Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 18-22 (June 2010)
Full text access
EPOC y enfermedad cardiovascular
Chronic obstructive pulmonary disease and cardiovascular disease
Visits
11490
José Luis Izquierdo Alonso
Servicio de Neumología, Hospital Universitario, Guadalajara, España
This item has received
Article information
Resumen

Durante la última década se ha indicado que la enfermedad pulmonar obstructiva crónica (EPOC) podría favorecer la aparición de cardiopatía isquémica. Varios estudios observacionales y de casos y controles han confirmado que los pacientes con EPOC tienen un riesgo mayor de presentar trastornos cardiovasculares. Sin embargo, este riesgo aumentado podría justificarse en gran parte por una prevalencia mayor de factores de riesgo clásicos. Actualmente, no hay datos que permitan establecer una relación de causalidad entre la EPOC y las enfermedades cardiovasculares, y el concepto de inflamación sistémica como mecanismo patogénico común no está demostrado. Tampoco hay suficiente evidencia para poder afirmar que ciertos fármacos, como estatinas o corticoides inhalados, a través de una reducción de la inflamación sistémica, puedan incidir de forma favorable en el riesgo cardiovascular del paciente con EPOC. Actualmente, sólo deben recomendarse cuando el paciente presente una situación específica que aconseje su uso.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Enfermedad cardiovascular
Inflamación sistémica
Abstract

In the last decade, various studies have suggested that chronic obstructive pulmonary disease (COPD) could favor the development of ischemic heart disease. Several observational and case-control studies have confirmed that patients with COPD have a higher risk of cardiovascular disorders. However, this increased risk could be largely explained by a greater prevalence of classical risk factors. Currently, there are no data to indicate a causal relation between COPD and cardiovascular disease and the concept of systemic inflammation as a common pathogenic mechanism has not been demonstrated. Equally, there is insufficient evidence to conclude that some drugs, such as statins or inhaled corticoids, could decrease cardiovascular risk in patients with COPD by reducing systemic inflammation. Currently, these drugs should only be recommended if patients show specific indications for their use.

Keywords:
Chronic obstructive pulmonary disease
Cardiovascular disease
Systemic inflammation
Full text is only aviable in PDF
Bibliografía
[1.]
J. Soriano, J.L. Izquierdo.
La EPOC en la vida y en la muerte.
Arch Bronconeumol, 42 (2006), pp. 421-422
[2.]
B.R. Celli, C.G. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Mendez, et al.
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[3.]
M.A. Puhan, J. Garcia-Aymerich, M. Frey, G. Ter Riet, J.M. Antó, A.G. Agustí, et al.
Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index.
[4.]
R.C. Jones, G.C. Donaldson, N.H. Chavannes, K. Kida, M. Dickson-Spillmann, S. Harding, et al.
Derivation and Validation of a Composite Index of Severity in Chronic Obstructive Pulmonary Disease - The DOSE Index.
Am J Respir Crit Care Med, 180 (2009), pp. 1189-1195
[5.]
J.J. Soler-Cataluña, M.A. Martínez-García, P. Román Sánchez, E. Salcedo, M. Navarro, R. Ochando.
Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.
Thorax, 60 (2005), pp. 925-931
[6.]
D.L. Bhatt, E.J. Topol.
Need to test the arterial inflammation hypothesis.
Circulation, 106 (2002), pp. 136-140
[7.]
R. Arroyo-Espliguero, P. Avanzas, J.C. Kaski.
Atherosclerotic coronary artery disease: usefulness of C-reactive protein for the identification of the vulnerable plaque and the vulnerable patient.
Rev Esp Cardiol, 57 (2004), pp. 375-378
[8.]
D.D. Sin, 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
[9.]
P. Man, J.E. Connett, N.R. Anthonisen, R.A. Wise, D.P. Tashkin, D.D. Sin.
C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease.
Thorax, 61 (2006), pp. 849-853
[10.]
M. Dahl, J. Vestbo, P. Lange, S.E. Bojesen, A. Tybjaerg-Hansen, B.G. Nordestgaard.
C-reactive Protein As a Predictor of Prognosis in Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med, 175 (2007), pp. 250-255
[11.]
J.A. Wedzicha, T.A. Seemungal, P.K. MacCallum, E.A. Paul, G.C. Donaldson, A. Bhowmik, et al.
Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels.
Thromb Haemost, 84 (2000), pp. 210-215
[12.]
J.L. Izquierdo Alonso, R. Arroyo Espliguero.
EPOC y riesgo Cardiovascular.
Arch Bronconeumol, 41 (2005), pp. 410-412
[13.]
J.P. De Torres, V. Pinto-Plata, C. Casanova, H. Mullerova, E. Córdoba-Lanús, M. Muros de Fuentes, et al.
C-reactive protein levels and survival in patients with moderate to very severe COPD.
Chest, 133 (2008), pp. 1336-1343
[14.]
P.W.F. Wilson, B.H. Nam, M. Pencina, R.B. D’Agostino, E.J. Benjamin, C.J. O’Donnell.
C-Reactive Protein and Risk of Cardiovascular Disease in Men and Women From the Framingham Heart Study.
Arch Intern Med, 165 (2005), pp. 2473-2478
[15.]
A. Agustí.
EPOC e inflamación sistémica. Una vía de enlace para la comorbilidad.
Arch Bronconeumol, 45 (2009), pp. 14-17
[16.]
J.L. Izquierdo, C. Almonacid, T. Parra, J. Perez.
Inflamación y estrés oxidativo en dos fenotipos de EPOC.
Arch Bronconeumol, 42 (2006), pp. 332-337
[17.]
A.M. Wilson, M.C. Ryan, A.J. Boyle.
The novel role of C-reactive protein in cardiovascular disease: Risk marker or pathogen.
Int J Cardiol, 106 (2006), pp. 291-297
[18.]
R. Nicholas, M.D. Anthonisen, A. Melissa, M.S. Skeans, M.D. Wise, J. Manfreda, et al.
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality.
Ann Intern Med, 142 (2005), pp. 233-239
[19.]
J. Hole, G.C. Watt, Davey-Smith, C.L. Hart, C.R. Gillis, V.M. Hawthorne.
Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study.
BMJ, 313 (1996), pp. 711-715
[20.]
P. Jousilahti, E. Vartiainen, J. Tuomilehto, P. Puska.
Symptoms of chronic bronchitis and the risk of coronary disease.
[21.]
H.J. Schünemann, J. Dorn, B.J.B. Grant, W. Winkelstein, M. Trevisan.
Pulmonary Function Is a Long-term Predictor of Mortality in the General Population: 29-Year Follow-up of the Buffalo Health Study.
Chest, 118 (2000), pp. 656-664
[22.]
D.M. Mannino, A.S. Buist, T.L. Petty, P.L. Enright, S.C. Redd.
Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study.
Thorax, 58 (2003), pp. 388-393
[23.]
G. Engstrom, P. Wollmer, B. Hedblad, S. Juul-Moller, S. Valind, L. Janzon.
Occurrence and prognostic significance of ventricular arrhythmia is related to pulmonary function: a study from “men born in 1914”, Malmo, Sweden.
Circulation, 103 (2001), pp. 3086-3091
[24.]
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
[25.]
S. Curkendall, C. DeLuise, J.K. Jones, S. Lanes, M.R. Stang, E. Goehring, et al.
Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada cardiovascular disease in COPD patients.
Ann Epidemiol, 16 (2006), pp. 63-70
[26.]
D. Liao, M. Higgins, N.R. Bryan, M.L. Eigenbrodt, L.E. Chambless, V. Lamar, et al.
Lower pulmonary function and cerebral subclinical abnormalities detected by MRI: the Atherosclerosis Risk in Communities study.
Chest, 116 (1999), pp. 150-156
[27.]
A.B. Newman, B.L. Naydeck, K. Sutton-Tyrrell, A. Feldman, D. Edmundowicz, L.H. Kuller.
Coronary artery calcification in older adults to age 99: prevalence and risk factors.
Circulation, 104 (2001), pp. 2679-2684
[28.]
H. Iwamoto, A. Yokoyama, Y. Kitahara, N. Ishikawa, Y. Haruta, K. Yamane, et al.
Airflow limitation in smokers is associated with subclinical aterosclerosis.
Am J Respir Crit Care Med, 179 (2009), pp. 35-40
[29.]
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
[30.]
P. Lucas-Ramos, J.L. Izquierdo-Alonso, J.M. Rodríguez-González Moro, J.M. Bellón Cano, J. Ancochea-Bermúdez, M. Calle-Rubio, et al.
Asociación de factores de riesgo cardiovascular y EPOC. Resultados de un estudio epidemiológico (estudio ARCE).
Arch Bronconeumol, 238 (2008), pp. 233-238
[31.]
J.L. Izquierdo, A. Martínez, E. Guzmán, B. Arnalich, C. Almonacid, P. Resano.
Chronic obstructive pulmonary disease does not increase the risk of ischemic heart disease.
Eur Respir J, 34 (2009), pp. 68s
[32.]
D.D. Sin, P. Lacy, E. York, S.F.P. Man.
Effects of fluticasone on systemic markers of inflamation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 170 (2004), pp. 760-765
[33.]
R. Arroyo-Espliego, P. Avanzas, S. Jefery, J.C. Kaski.
CD 14 and toll-like receptor 4: a link between infection and acute coronary events?.
Heart, 90 (2004), pp. 983-988
[34.]
M. Roland, A. Bhowmik, R.J. Sapsford, T.A. Seemungal, D.J. Jeffries, T.D. Warner, et al.
Sputum and plasma endothelin-1 levels in exacerbations of chronic obstructive pulmonary disease.
Thorax, 56 (2001), pp. 30-35
[35.]
J.A. Wedzicha, T.A. Seemungal, P.K. MacCallum, E.A. Paul, G.C. Donaldson, A. Bhowmik, et al.
Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels.
Thromb Haemost, 84 (2000), pp. 210-215
[36.]
G.B. Mancini, M. Etminan, B. Zhang, L.E. Levesque, J.M. FitzGerald, J.M. Brophy.
Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease.
J Am Coll Cardiol, 47 (2006), pp. 2554-2560
[37.]
A.M. Wilson, M.C. Ryan, A.J. Boyle.
The novel role of C-reactive protein in cardiovascular disease: Risk marker or pathogen.
Int J Cardiol, 106 (2006), pp. 291-297
[38.]
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
[39.]
C.M. Boyd, J. Darer, C. Boult, L.P. Fried, L. Boult, A.W. Wu.
Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance.
JAMA, 294 (2005), pp. 716-724
[40.]
P.M. Calverley, J.A. Anderson, B. Celli, G.T. Ferguson, C. Jenkins, P.W. Jones, TORCH investigators, et al.
Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.
N Engl J Med, 356 (2007), pp. 775-789
[41.]
D.D. Sin, S.F. Man, D.D. Marciniuk, G. Ford, M. FitzGerald, E. Wong, et al.
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
[42.]
D.P. Tashkin, B. Celli, S. Senn, D. Burkhart, S. Kesten, S. Menjoge, for the UPLIFT Study Investigators, et al.
A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease.
N Engl J Med, 359 (2008), pp. 1543-1554
[43.]
J. Garcia-Aymerich, P. Lange, M. Benet, P. Schnohr, J.M. Anto.
Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.
Thorax, 61 (2006), pp. 772-778
[44.]
E. Selvin, N.P. Paynter, T.P. Erlinger.
The Effect of Weight Loss on C-Reactive Protein. A Systematic Review.
Arch Intern Med, 167 (2007), pp. 31-39
[45.]
D. Aronson, I. Roterman, M. Yigla, A. Kerner, O. Avizohar, R. Sella, et al.
Inverse Association between Pulmonary Function and C-Reactive Protein in Apparently Healthy Subjects.
Am J Respir Crit Care Med, 174 (2006), pp. 626-632
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

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