The 'double dip' hypothesis: simultaneous prevention of cardiovascular and pulmonary morbidity and mortality using angiotensin II type 1 receptor blockers.

Abstract

The therapy for chronic obstructive lung disease (COPD) is largely symptomatic in nature, involving the use of bronchodilators and steroids, and the judicious use of antibiotics. None of these have been shown to have a consistent beneficial impact on outcome. Moreover, the outcome of patients with COPD is determined, to some extent, by the occurrence of cardiovascular events. The association between pulmonary disease and cardiovascular events is gaining greater recognition, and appears inexplicable solely on the basis of shared, traditional risk factors, such as smoking. There appear to be direct links between lung injury and concomitant vascular injury by virtue of a systemic inflammatory state induced by lung inflammation. The present paper raises the possibility that the outcome of patients with COPD may be improved significantly through aggressive use of therapies known to prevent cardiovascular events. Moreover, angiotensin II is also a direct mediator of lung injury; interruption of this mechanism of injury might simultaneously prevent both cardiovascular and pulmonary morbidity and mortality in patients with chronic lung disease.