Heffernan Michael, Rutherford Samantha
Division of Cardiology, Halton Healthcare, Oakville, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
CJC Open. 2025 Jan 8;7(4):493-507. doi: 10.1016/j.cjco.2025.01.001. eCollection 2025 Apr.
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are 2 prevalent and interconnected health conditions that have a significant global impact. COPD is characterized by airflow obstruction and is caused by smoking and/or environmental factors. COPD is associated with chronic inflammation and structural changes in the airways and lung parenchyma. CVD encompasses various cardiac and vascular conditions and is a leading global cause of mortality, with risk factors that include diabetes, smoking, and dyslipidemia. CVDs discussed in this review, in relation to COPD, include hypertension, coronary artery disease and ischemic heart disease, heart failure, cardiac arrhythmias, and cerebrovascular disease. The interplay between COPD and CVD is evident, with shared risk factors and physiological mechanisms contributing to their frequent comorbidity. Therefore, an integrated approach to care involving primary care physicians, respirologists, and cardiologists is essential to effectively manage the dual burden of COPD and CVD. This review outlines the shared risks and underlying mechanisms of these conditions, their diagnosis, and the clinical implications of dual COPD and CVD in a patient, including how COPD exacerbations significantly elevate the risk of cardiovascular (CV) events and mortality. Pharmacologic CVD and COPD therapies, as well as their CV and respiratory effects, are discussed. Key trials (Towards a Revolution in COPD Health [TORCH]; Study to Understand Mortality and Morbidity in COPD [SUMMIT]; InforMing the Pathway of COPD Treatment [IMPACT]; and fficacy and Safety of Triple erapy in bstructive Lung Diease [ETHOS]) are discussed that demonstrate the effectiveness of triple bronchodilator therapy in reducing exacerbation rates, as well as all-cause and cardiovascular mortality in patients with COPD and CVD. Overall, this review highlights the need for an integrated approach to patient management, involving collaboration among primary care physicians, respirologists, and cardiologists, to effectively address the dual burden of these diseases.
慢性阻塞性肺疾病（COPD）和心血管疾病（CVD）是两种普遍存在且相互关联的健康状况，对全球具有重大影响。COPD的特征是气流阻塞，由吸烟和/或环境因素引起。COPD与气道和肺实质的慢性炎症及结构变化相关。CVD包括各种心脏和血管疾病，是全球主要的死亡原因，其风险因素包括糖尿病、吸烟和血脂异常。本综述中讨论的与COPD相关的CVD包括高血压、冠状动脉疾病和缺血性心脏病、心力衰竭、心律失常以及脑血管疾病。COPD和CVD之间的相互作用很明显，共同的风险因素和生理机制导致它们经常合并存在。因此，由初级保健医生、呼吸科医生和心脏病专家参与的综合护理方法对于有效管理COPD和CVD的双重负担至关重要。本综述概述了这些疾病的共同风险和潜在机制、它们的诊断以及COPD和CVD双重疾病在患者中的临床意义，包括COPD急性加重如何显著提高心血管（CV）事件和死亡风险。还讨论了心血管疾病和COPD的药物治疗及其对心血管和呼吸系统的影响。文中讨论了一些关键试验（慢性阻塞性肺疾病健康革命研究[TORCH]；了解慢性阻塞性肺疾病的死亡率和发病率研究[SUMMIT]；明确慢性阻塞性肺疾病治疗途径研究[IMPACT]；以及阻塞性肺疾病三联疗法的疗效和安全性研究[ETHOS]），这些试验证明了三联支气管扩张剂疗法在降低COPD和CVD患者的急性加重率以及全因死亡率和心血管死亡率方面的有效性。总体而言，本综述强调了患者管理需要综合方法，包括初级保健医生、呼吸科医生和心脏病专家之间的协作，以有效应对这些疾病的双重负担。
