Bianco Andrea, Pagliaro Raffaella, Schiattarella Angela, Mariniello Domenica Francesca, D'Agnano Vito, Cianci Roberta, Nigro Ersilia, Daniele Aurora, Scialò Filippo, Perrotta Fabio
Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy.
Unit of Respiratory Medicine "Luigi Vanvitelli", A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy.
Biomedicines. 2025 Jul 24;13(8):1817. doi: 10.3390/biomedicines13081817.
Chronic Obstructive Pulmonary Disease (COPD) is a multifactorial condition associated with significant systemic complications such as cardiovascular disease (CVD), metabolic disorders, muscle wasting, and sarcopenia. While Body Mass Index (BMI) is a well-established indicator of obesity and has prognostic value in COPD, its role in predicting disease outcomes is complex. Muscle wasting is prevalent in COPD patients and exacerbates disease severity, contributing to poor physical performance, reduced quality of life, and increased mortality. Additionally, COPD is linked to metabolic disorders, such as dyslipidemia and diabetes, which contribute to systemic inflammation and worse prognosis and, therefore, should be treated. The systemic inflammatory response plays a central role in the development of sarcopenia. In this review, we highlight the mixed efficacy of statins in managing dyslipidemia in COPD, considering side effects, including muscle toxicity in such a frail population. Alternative lipid-lowering therapies and nutraceuticals, in addition to standard treatment, have the potential to target hypercholesterolemia, which is a coexisting condition present in more than 50% of all COPD patients, without worsening muscle wasting. The interference between adipose tissue and lung, and particularly the potential protective role of adiponectin, an adipocytokine with anti-inflammatory properties, is also reviewed. Respiratory, metabolic and muscular health in COPD is comprehensively assessed. Identifying and managing dyslipidemia and paying attention to other relevant COPD comorbidities, such as sarcopenia and muscle wasting, is important to improve the quality of life and to reduce the clinical burden of COPD patients. Future research should focus on understanding the relationships between these intimate mechanisms to facilitate specific treatment for systemic involvement of COPD.
慢性阻塞性肺疾病（COPD）是一种多因素疾病，与心血管疾病（CVD）、代谢紊乱、肌肉萎缩和肌肉减少症等严重的全身并发症相关。虽然体重指数（BMI）是公认的肥胖指标，且在COPD中具有预后价值，但其在预测疾病结局中的作用较为复杂。肌肉萎缩在COPD患者中很普遍，会加重疾病严重程度，导致身体机能下降、生活质量降低和死亡率增加。此外，COPD与代谢紊乱有关，如血脂异常和糖尿病，这些会导致全身炎症和预后变差，因此需要治疗。全身炎症反应在肌肉减少症的发展中起核心作用。在本综述中，我们强调了他汀类药物在治疗COPD患者血脂异常方面的混合疗效，同时考虑到其副作用，包括在如此虚弱人群中的肌肉毒性。除标准治疗外，替代降脂疗法和营养保健品有可能针对高胆固醇血症，这是超过50%的COPD患者共存的情况，且不会加重肌肉萎缩。还综述了脂肪组织与肺之间的相互作用，特别是脂联素（一种具有抗炎特性的脂肪细胞因子）的潜在保护作用。对COPD患者的呼吸、代谢和肌肉健康进行了全面评估。识别和管理血脂异常，并关注其他相关的COPD合并症，如肌肉减少症和肌肉萎缩，对于提高生活质量和减轻COPD患者的临床负担很重要。未来的研究应侧重于理解这些密切机制之间的关系，以便为COPD的全身受累提供针对性治疗。
