Chronic Obstructive Pulmonary Disease and Cardiovascular Disorders.

Abstract

Chronic obstructive pulmonary disease (COPD) remains a significant global public health challenge, plagued by substantial morbidity and mortality worldwide; it is one of the main causes of death worldwide, especially during episodes of severe exacerbation. There is a higher COPD burden noted in regions with high smoking prevalence, air pollution, and faster socioeconomic development. There is also a high number of cardiovascular (CV) comorbidities among these patients, pointing to a need for routine CV screening in such circumstances. These two diseases, COPD and CV disease (CVD), are associated via an intricate and multifactorial interplay characterized by convergent risk factors, systemic inflammation, and interlinked pathophysiological mechanisms, with atherosclerosis being a principal inflammatory process linking these two disorders, driven by systemic inflammation, oxidative stress, and endothelial dysfunction. Importantly, despite the fact that CVD is common in COPD, it remains underdiagnosed and undertreated due to overlapping respiratory and cardiac symptomatology. The latter issue is accentuated in the case of heart failure (HF) and coronary artery disease (CAD), whereby HF atypical symptoms may mimic the clinical picture of COPD exacerbation and CAD presenting with atypical symptomatology such as dyspnea on exertion and/or fatigue, which may point to HF/COPD worsening. Thus, a structured CV assessment and management following exacerbations of COPD is needed in order to identify CAD and/or other new heart disease in these patients and guide appropriate management. These issues are discussed with relevant metaanalyses and key guidelines tabulated, and the involved interrelated mechanisms are pictorially illustrated.