Frequency of occurrence of risk factors of cardiovascular diseases and assessment of the total cardiovascular risk in patients with chronic obstructive pulmonary disease (COPD)

K. Klester, E. Klester, A. Zharikov, A. Balitskaya, A. Denisova
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Abstract

Introduction: Cardiovascular diseases are diagnosed in more than half of patients and aggravate the course of COPD. Objective: To assess the frequency of risk factors of cardiovascular disease and the degree of total cardiovascular risk in patients with COPD. Materials and Methods: 518 patients were under supervision, 122 of them (with mild and moderate СOPD (GOLD, 2018) were included in the final analysis, satisfying the inclusion criteria: the absence of clinical manifestations of cardiovascular disease, MI and stroke history, DM. The European SCORE scale was used to assess coronary risk. Results: Low total cardiovascular risk was diagnosed in 15 (12%), medium – in 29 (24%), high – in 41 (34%), very high risk by SCORE – in 37 (30%) COPD patients. A regression analysis revealed correlation between the risk of COPD exacerbations (mMRC or CAT, severity according to spirometry) and the total cardiovascular risk of SCORE (r = 0.58; p = 0.001), as well as between the comorbidity index by M. Charlson et al. (1987) and risk by SCORE (r = 0.61; p = 0.006). The relationship between BMI and cholesterol in the study was J-shaped. The effect of inhalation therapy on the occurrence of the first manifestation of CVD was not established by Cox regression. Conclusion: in 75% of patients with COPD, an increased 10-year risk of all fatal complications of atherosclerosis is determined. The study indicates the need to assess the risk by SCORE in patients with initial manifestations of COPD in order to timely correction of the identified risk factors for cardiovascular disease.
慢性阻塞性肺疾病(COPD)患者心血管疾病危险因素发生频率及心血管总危险评估
超过一半的患者被诊断为心血管疾病,并加重COPD病程。目的:评价慢性阻塞性肺病患者心血管疾病危险因素发生频率及心血管总危险程度。材料与方法:518例患者接受监测,其中122例(轻、中度СOPD (GOLD, 2018))纳入最终分析,符合纳入标准:无心血管疾病临床表现、心肌梗死和卒中史、糖尿病。采用欧洲SCORE量表评估冠状动脉风险。结果:COPD患者总心血管风险低15例(12%),中等29例(24%),高41例(34%),评分非常高37例(30%)。回归分析显示COPD恶化风险(mMRC或CAT,根据肺活量测定的严重程度)与SCORE总心血管风险之间存在相关性(r = 0.58;p = 0.001),以及M. Charlson等人(1987)的合并症指数与SCORE的风险之间的关系(r = 0.61;P = 0.006)。在研究中,BMI和胆固醇的关系呈j型。吸入治疗对CVD首发表现的影响尚未通过Cox回归确定。结论:在75%的COPD患者中,所有致命的动脉粥样硬化并发症的10年风险增加。本研究提示有必要对COPD初始表现患者进行SCORE风险评估,以便及时纠正已确定的心血管疾病危险因素。
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