Crisan Liliana, Wong Nathan, Sin Don D, Lee Hwa Mu
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, United States.
Division of Respiratory Medicine, Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, Vancouver, BC, Canada.
Front Cardiovasc Med. 2019 Jun 25;6:79. doi: 10.3389/fcvm.2019.00079. eCollection 2019.
There is compelling epidemiological evidence that airway exposure to cigarette smoke, air pollution particles, as well as bacterial and viral pathogens is strongly related to acute ischemic events. Over the years, there have been important animal and human studies that have provided experimental evidence to support a causal link. Studies show that patients with cardiovascular diseases (CVDs) or risk factors for CVD are more likely to have major adverse cardiovascular events (MACEs) after an acute exacerbation of chronic obstructive pulmonary disease (COPD), and patients with more severe COPD have higher cardiovascular mortality and morbidity than those with less severe COPD. The risk of MACEs in acute exacerbation of COPD is determined by the complex interactions between genetics, behavioral, metabolic, infectious, and environmental risk factors. To date, there are no guidelines regarding the prevention, screening, and management of the modifiable risk factors for MACEs in the context of COPD or COPD exacerbations, and there is insufficient CVD risk control in those with COPD. A deeper insight of the modifiable risk factors shared by CVD, COPD, and acute exacerbations of COPD may improve the strategies for reduction of MACEs in patients with COPD through vaccination, tight control of traditional CV risk factors and modifying lifestyle. This review summarizes the most recent studies regarding the pathophysiology and epidemiology of modifiable risk factors shared by CVD, COPD, and COPD exacerbations that could influence overall morbidity and mortality due to MACEs in patients with acute exacerbations of COPD.
有令人信服的流行病学证据表明，气道暴露于香烟烟雾、空气污染颗粒以及细菌和病毒病原体与急性缺血性事件密切相关。多年来，重要的动物和人体研究提供了实验证据来支持因果关系。研究表明，患有心血管疾病（CVD）或有CVD风险因素的患者在慢性阻塞性肺疾病（COPD）急性加重后更有可能发生主要不良心血管事件（MACE），且COPD病情越严重的患者，其心血管死亡率和发病率高于病情较轻的COPD患者。COPD急性加重时发生MACE的风险由遗传、行为、代谢、感染和环境风险因素之间的复杂相互作用决定。迄今为止，尚无关于COPD或COPD加重情况下MACE可改变风险因素的预防、筛查和管理的指南，且COPD患者的心血管疾病风险控制不足。深入了解CVD、COPD以及COPD急性加重所共有的可改变风险因素，可能会通过疫苗接种、严格控制传统心血管风险因素和改变生活方式来改善降低COPD患者MACE的策略。本综述总结了关于CVD、COPD以及COPD急性加重所共有的可改变风险因素的病理生理学和流行病学的最新研究，这些因素可能会影响COPD急性加重患者因MACE导致的总体发病率和死亡率。
