Hawkins Nathaniel M, Kaplan Alan, Ko Dennis T, Penz Erika, Bhutani Mohit
Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, 2775 Laurel Street, 9th Floor Room 9123, Vancouver, BC, V5Z 1M9, Canada.
Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada.
Pulm Ther. 2024 Dec;10(4):363-376. doi: 10.1007/s41030-024-00270-2. Epub 2024 Sep 9.
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) have a syndemic relationship with shared risk factors and complex interplay between genetic, environmental, socioeconomic, and pathophysiological mechanisms. CVD is among the most common comorbidities in patients with COPD and vice versa. Patients with COPD, irrespective of their disease severity, are at increased risk of CVD morbidity and mortality, driven in part by COPD exacerbations. Despite these known interrelationships, CVD is underestimated and undertreated in patients with COPD. Similarly, COPD is an independent risk-enhancing factor for adverse cardiovascular (CV) events, yet it is not incorporated into current CV risk assessment tools, leading to under-recognition and undertreatment. There is a pressing need for systems change in COPD management to move beyond symptom control towards a comprehensive cardiopulmonary disease paradigm with proactive prevention of exacerbations and adverse cardiopulmonary outcomes and mortality. However, there is a dearth of evidence defining optimal cardiopulmonary care pathways. Fortunately, there is a precedent to support systems-level change in the field of diabetes, which evolved from glycemic control to comprehensive multi-organ risk assessment and management. Key elements included integrated multidisciplinary care, intensive risk factor management, coordination between primary and specialist care, care pathways and protocols, education and self management, and disease-modifying therapies. This commentary article draws parallels between the cardiometabolic and cardiopulmonary paradigms and makes a case for systems change towards multidisciplinary, integrated cardiopulmonary care, using the evolution in diabetes care as a potential framework.
慢性阻塞性肺疾病（COPD）与心血管疾病（CVD）存在共病关系，它们有共同的危险因素，并且在遗传、环境、社会经济和病理生理机制之间存在复杂的相互作用。CVD是COPD患者中最常见的合并症之一，反之亦然。COPD患者无论疾病严重程度如何，发生CVD发病和死亡的风险都会增加，部分原因是COPD急性加重。尽管存在这些已知的相互关系，但COPD患者中的CVD仍被低估且治疗不足。同样，COPD是不良心血管（CV）事件的独立风险增强因素，但它未被纳入当前的CV风险评估工具中，导致识别不足和治疗不足。迫切需要对COPD管理进行系统变革，从症状控制转向全面的心肺疾病模式，积极预防急性加重以及不良心肺结局和死亡。然而，缺乏定义最佳心肺护理途径的证据。幸运的是，糖尿病领域支持系统层面变革有先例，糖尿病已从血糖控制发展到全面的多器官风险评估和管理。关键要素包括综合多学科护理、强化危险因素管理、初级护理与专科护理之间的协调、护理途径和方案、教育与自我管理以及疾病改善疗法。这篇评论文章比较了心脏代谢和心肺模式，并以糖尿病护理的演变作为潜在框架，论证了朝着多学科、综合心肺护理进行系统变革的必要性。
