Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts and the London National Institute of Health Research Biomedical Research Unit, The London Chest Hospital, Bonner Road, London E2 9JX, UK.
Heart. 2012 Jul;98(14):1055-62. doi: 10.1136/heartjnl-2012-301759.
Significant cardiac morbidity and mortality exists in patients with COPD. Shared risk factors include age, smoking history and exposure to air pollution and passive smoke. Although the inappropriate under-prescribing of β-blockers contributes, it is now appreciated that the observed cardiac risk is not only due to smoking and conventional cardiovascular risk factors, but also other independent factors. A number of hypotheses exist for the increased cardiovascular morbidity and mortality seen in COPD including inflammation, pulmonary hypertension, lung hyperinflation and shared genetics models. Mounting evidence from large randomised controlled trials suggests that COPD treatment may be cardio-protective. We review the current evidence supporting the aforementioned hypotheses and how their modulation may prevent cardiovascular morbidity and mortality in COPD. The persisting underdiagnosis of COPD may have significant consequences. Further mechanistic studies identifying the onset and impact of individual interventions will develop our understanding of this emerging and highly relevant clinical field.
COPD 患者存在显著的心脏发病率和死亡率。共同的风险因素包括年龄、吸烟史以及暴露于空气污染和被动吸烟。虽然β受体阻滞剂的不适当的用药不足会导致这种情况，但现在人们已经认识到，观察到的心脏风险不仅是由于吸烟和传统的心血管危险因素，还有其他独立的因素。在 COPD 中观察到的心血管发病率和死亡率增加的原因有很多种假说，包括炎症、肺动脉高压、肺过度充气和共同的遗传模型。来自大型随机对照试验的越来越多的证据表明，COPD 治疗可能具有心脏保护作用。我们回顾了支持上述假说的现有证据，以及它们的调节如何预防 COPD 中的心血管发病率和死亡率。COPD 的持续漏诊可能会产生重大影响。进一步的机制研究确定了个体干预的开始和影响，将有助于我们理解这一新兴的、高度相关的临床领域。
