The Intersection of Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: Recent Insights in a Challenging Area

Abstract

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are 2 prevalent and interconnected health conditions that have a significant global impact. COPD is characterized by airflow obstruction and is caused by smoking and/or environmental factors. COPD is associated with chronic inflammation and structural changes in the airways and lung parenchyma. CVD encompasses various cardiac and vascular conditions and is a leading global cause of mortality, with risk factors that include diabetes, smoking, and dyslipidemia. CVDs discussed in this review, in relation to COPD, include hypertension, coronary artery disease and ischemic heart disease, heart failure, cardiac arrhythmias, and cerebrovascular disease. The interplay between COPD and CVD is evident, with shared risk factors and physiological mechanisms contributing to their frequent comorbidity. Therefore, an integrated approach to care involving primary care physicians, respirologists, and cardiologists is essential to effectively manage the dual burden of COPD and CVD.

This review outlines the shared risks and underlying mechanisms of these conditions, their diagnosis, and the clinical implications of dual COPD and CVD in a patient, including how COPD exacerbations significantly elevate the risk of cardiovascular (CV) events and mortality. Pharmacologic CVD and COPD therapies, as well as their CV and respiratory effects, are discussed. Key trials (Towards a Revolution in COPD Health [TORCH]; Study to Understand Mortality and Morbidity in COPD [SUMMIT]; InforMing the Pathway of COPD Treatment [IMPACT]; and Efficacy and Safety of Triple Therapy in Obstructive Lung Disease [ETHOS]) are discussed that demonstrate the effectiveness of triple bronchodilator therapy in reducing exacerbation rates, as well as all-cause and cardiovascular mortality in patients with COPD and CVD. Overall, this review highlights the need for an integrated approach to patient management, involving collaboration among primary care physicians, respirologists, and cardiologists, to effectively address the dual burden of these diseases.