Pulmonology Service/Unit, Monographic COPD Consultation. Regional University Hospital of Malaga, Malaga, Spain.
Nephrology Department, Regional University Hospital of Malaga, University of Malaga, The Biomedical Research Institute of Malaga (IBIMA), RICORS2040 (RD21/0005/0012), Malaga, Spain.
Respir Med. 2024 Oct;232:107740. doi: 10.1016/j.rmed.2024.107740. Epub 2024 Jul 14.
Chronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients.
This was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70 % and FEV1 <80 % predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-min walking test [6MWT]). CVR was assessed using different risk prediction models.
A total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72 %; arterial hypertension: 70 %, dyslipidemia: 30 %, diabetes: 20 %; CV disease (CVD): 24 %. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p < 0.001); patients with ≥30-m increase on the 6MWT showed statistically significant lower levels of glucose (p = 0.004), HbA1c (p = 0.004) and BODE index score (p = 0.026) compared to patients with <30-m increase.
PR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.
慢性阻塞性肺疾病（COPD）是主要死因之一，心血管（CV）合并症起作用。关于肺康复（PR）对降低 COPD 患者心血管风险（CVR）的效果的证据有限。在本研究中，我们旨在确定 8 周 PR 方案（PRP）对总体人群的 CVR 的影响，并比较对加重者与非加重者的影响。
这是一项前瞻性研究，纳入了支气管扩张剂后用力呼气量 1 秒（FEV1）与用力肺活量（FVC）的比值（FEV1/FVC）<70%且 FEV1 <80%预计值、戒烟至少 1 年且有吸烟史>10 包/年、在过去 8 周内临床稳定的成年人。PRP 前后评估包括呼吸功能评估、实验室检查和运动能力评估（6 分钟步行试验 [6MWT]）。使用不同的风险预测模型评估 CVR。
共有 50 名患者（28 名加重者和 22 名非加重者）完成了 PRP（中位数年龄：64.5 岁，男性：72%；动脉高血压：70%，血脂异常：30%，糖尿病：20%；心血管疾病 [CVD]：24%）。PRP 后，COPDCoRi 模型计算的加重者 CVR 显著下降（p<0.001）；6MWT 增加≥30m 的患者血糖（p=0.004）、HbA1c（p=0.004）和 BODE 指数评分（p=0.026）显著低于增加<30m 的患者。
PR 降低了某些可改变的 CVR 因素和 CVD 风险，尤其是在加重者中。
