Сердечно-сосудистые заболевания и хронические обструктивные болезни легких: патофизиологические особенности и выбор тактики лечения
DOI: 10.26442/00403660.2020.03.000456
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Ambatiello L.G., Chazova I.E. Cardiovascular and chronic obstructive pulmonary diseases: pathophysiological processes and treatment tactics. Therapeutic Archive. 2020; 92 (3): 78–83. DOI: 10.26442/00403660.2020.03.000456
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Ключевые слова: сердечно-сосудистые заболевания, ишемическая болезнь сердца, хроническая обструктивная болезнь легких, коморбидность.
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Due to the global aging of the population, the deteriorating ecology and lifestyle changes, patients with isolated cardiovascular diseases (CVD) are becoming less common, and the portrait of a comorbid patient comes first in the structure of patients with CVD. Among a number of diseases complicating and concomitant with cardiovascular, a special place is occupied by chronic obstructive pulmonary disease (COPD). The prevalence of COPD among CVD patients can reach 60%. Many of the pathophysiological mechanisms underlying COPD can increase the risk of cardiovascular disease and vice versa. The most common cases of COPD are arterial hypertension, coronary heart disease, heart failure, and atrial fibrillation. Given the close relationship between COPD and CVD, it is clear that treatment for one condition can affect another. This review discusses current positions about the influence of both groups of diseases on each other, and also observes the effects of drug therapy of both diseases.
Keywords: cardiovascular diseases, coronary heart disease, chronic obstructive pulmonary disease, comorbidity.
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1. Eriksson B, Lindberg A, Müllerova H, et al. Association of heart diseases with COPD and restrictive lung function – Results from a population survey. Respiratory Medicine. 2013;107(1):98-106.
2. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest. 2005;127:1952-9. doi: 10.1378/chest.127.6.1952
3. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2(1):8-11. doi: 10.1513/pats.200404-032ms
4. Persson C, Bengtsson C, Lapidus L, et al. Peak expiratory flow and risk of cardiovascular disease and death. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Am J Epidemiol. 1986;124:942-8.
5. Sorlie PD, Kannel WB, O’Connor G. Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study. Am Rev Respir Dis. 1989;140:379-84.
6. Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev. 2018;27(149):180057. doi: 10.1183/16000617.0057-2018
7. Roversi S, Fabbri LM, Sin DD, et al. Chronic obstructive pulmonary disease and cardiac diseases. An urgent need for integrated care.
Am J Respir Crit Care Med. 2016;194:1319-36. doi: 10.1164/ rccm.201604-0690so
8. Zadionchenko VS, Adasheva TV, Fedorova IV, et al. Arterial hypertension and chronic obstructive pulmonary disease: clinico-pathogenetic parallels and therapeutic potential. Russian Journal of Cardiology. 2009;6:62-8 (In Russ.) doi: 10.15829/1560-4071-2009-6-62-68
9. Karoli NA, Rebrov AP. Comorbidity in patients with chronic obstructive pulmonary disease: a role of cardiovascular disorders. Rational Pharmacotherapy in Cardiology. 1999;5(4):9-16 (In Russ.) doi: 10.20996/1819-6446-2009-5-4-9-16
10. Anthonisen NR, Connett JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333-9. doi: 10.1164/rccm.2110093
11. Chazova IE. Arterial hypertension and chronic obstructive pulmonary disease. Consilium Medicum. 2006;8(5):21-5 (In Russ.)
12. Adasheva TV, Fedorova IV, Zadionchenko VS, et al. Clinic and functional characteristics of arterial hypertension in patients woth chronoc obstructive pulmonary disease. Serdce. 2009;6:345-51 (in Russ.)
13. Jousilahti P, Vartiainen E, Tuomilehto J, Puska P. Symptoms of chronic bronchitis and the risk of coronary disease. Lancet. 1996;348(9027):567-72.
14. Cavaillès A, Brinchault-Rabin G, Dixmier A, et al. Comorbidities of COPD. Euro Respir Rev. 2013;22(130):454-75. doi: 10.1183/ 09059180.00008612
15. Brekke PH, Omland P, Smith P, et al. Underdiagnosis of myocardial infarction in COPD – Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation. Respir Med. 2008;102(9):1243-47. doi: 10.1016/j.rmed.2008.04.010. Epub 2008 Jul 1.
16. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868-74. doi: 10.1038/nature01323
17. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.
J Am Coll Cardiol. 2013;62:263-71. doi: 10.1016/j.jacc.2013.02.092
18. Rossi A, Aisanov Z, Avdeev S, et al. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respir Med. 2015;109:785–802. doi: 10.1016/j.rmed.2015.03.010
19. O'Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: applying physiology to clinical practice. COPD Research and Practice. 2015;1(1):4. doi: 10.1186/s40749-015-0008-8
20. Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185:435-52. doi: 10.1164/rccm.201111-2042st
21. Global Initiative for Chronic Obstructive Lung Disease. Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for Health Care Professional. 2018 Report. Available at: https://goldcopd.org/wp-content/uploads/2018/02/WMS-GOLD-2018-Feb-Final-to-print-v2.pdf
22. Rennard SI. Clinical approach to patients with chronic obstructive pulmonary disease and cardiovascular disease. Proc Am Thorac Soc. 2005;2:94-100. doi: 10.1513/pats.200410-051sf
23. Watz H, Waschki B, Meyer T, et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest. 2010;138:32-8. doi: 10.1378/chest.09-2810
24. Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362:217-27. doi: 10.1056/nejmoa0808836
25. Cazzola M, Mantero A, Santus P, et al. Doppler echocardiographic assessment of the effects of inhaled long-acting b2-agonists on pulmonary artery pressure in COPD patients. Pulm Pharmacol Ther. 2007;20:258-64. doi: 10.1016/j.pupt.2006.02.002
26. Smith BM, Kawut SM, Bluemke DA, et al. Pulmonary hyperinflation and left ventricular mass: the Multi-Ethnic Study of Atherosclerosis COPD Study. Circulation. 2013;127:1503-11. doi: 0.1161/circulationaha.113.001653
27. Smith BM, Prince MR, Hoffman EA, et al. Impaired left ventricular filling in COPD and emphysema: is it the heart or the lungs? The Multi-Ethnic Study of Atherosclerosis COPD Study. Chest. 2013;144:1143-51. doi: 10.1378/chest.13-0183
28. Zangiabadi A, De Pasquale CG, Sajkov D. Pulmonary hypertension and right heart dysfunction in chronic lung disease. Biomed Res Int. 2014;2014:1-13. doi: 10.1155/2014/739674
29. Sievi NA, Clarenbach CF, Camen G, et al. High prevalence of altered cardiac repolarization in patients with COPD. BMC Pulm Med. 2014;14:55. doi: 10.1186/1471-2466-14-55
30. Freixa X, Portillo K, Paré C, et al. Echocardiographic abnormalities in patients with COPD at their first hospital admission. Eur Respir J. 2013;41(4):784-91. doi: 10.1183/09031936.00222511
31. Caglar IM, Dasli T, Turhan Caglar FN, et al. Evaluation of atrial conduction features with tissue Doppler imaging in patients with chronic obstructive pulmonary disease. Clin Res Cardiol. 2012;101:599-606. doi: 10.1007/s00392-012-0431-7
32. Rusinowicz T, Zielonka TM, Zycinska K. Cardiac Arrhythmias in Patients with Exacerbation of COPD. In: Pokorski M. (eds) Clinical Management of Pulmonary Disorders and Diseases. Advances in Experimental Medicine and Biology, Springer, Cham. 2017;1022. doi: 10.1007/5584_2017_41
33. Kunisaki KM, Dransfield MT, Anderson JA, et al. Exacerbations of chronic obstructive pulmonary disease and cardiac events: A Post Hoc Cohort Analysis from the SUMMIT Randomized Clinical Trial. Am J Respir Crit Care Med. 2018;198:51-7. doi: 10.1164/rccm.201711-2239OC
34. Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010;137:1091-7. doi: 10.1378/chest.09-2029
35. Liu Y, Liu X, Lin G, et al. Decreased CD34+ cell number is correlated with cardiac dysfunction in patients with acute exacerbation of COPD. Heart Lung Circ. 2014;23:875-82. doi: 10.1016/j.hlc.2014.03.008
36. Gan WQ, Man SF, Senthilselvan A, et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004;59:574-80. doi: 10.1136/thx.2003.019588
37. De Torres JP, Cordoba-Lanus E, Lopez-Aguilar C, et al. C-reactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J. 2006;27:902-7. doi: 10.1016/j.rmedu. 2006.03.011
38. Hurst JR, Donaldson GC, Perera WR, et al. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;174:867-74. doi: 10.1164/rccm.200604-506OC
39. Sin DD, Man SFP. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003;107:1514-9. doi: 10.1161/01.cir.0000056767.69054.b3
40. Roversi S, Roversi P, Spadafora G, et al. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest. 2014;44:93-102. doi: 10.1111/eci.12181
41. Morgan AD, Zakeri R, Quint JK. Defining the relationship between COPD and CVD: what are the implications for clinical practice? Ther Adv Respir Dis. 2018;12:1753465817750524. doi: 10.1177/ 1753465817750524
42. Criner GJ, Connett JE, Aaron SD, et al. Simvastatin for the prevention of exacerbations in moderate-to-severe COPD. N Engl J Med. 2014;370:2201-10. doi: 10.1056/nejmoa1403086
43. John ME, Cockcroft JR, McKeever TM, et al. Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2015;10:211-21. doi: 10.2147/copd.s76061
44. Miravitlles M, D'Urzo A, Singh D, et al. Pharmacological strategies to reduce exacerbation risk in COPD: a narrative review. Respir Res. 2016;17:112. doi: 10.1186/s12931-016-0425-5
45. Aisanov ZR, Avdeev SN, Arkhipov VV, et al. National clinical guidelines on diagnosis and treatment of chronic obstructive pulmonary disease: a clinical decision-making algorithm. Russian Pulmonology. 2017;27(1):13-20 (In Russ.) doi: 10.18093/0869-0189-2017-27-1-13-20
46. Chazova IE, Chuchalin AG, Zykov KA, et al. The diagnosis and treatment of patients with arterial hypertension and chronic obstructive inflammatory pulmonary diseases (Guidelines of the Russian Medical Society on Arterial Hypertension and the Russian Respiratory Society). Systemic Hypertension. 2013;10(1):5-34 (In Russ.)
47. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129-200. doi: 10.1093/eurheartj/ehw128
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Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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L.G. Ambatiello, I.E. Chazova
Myasnikov Research Institute of Clinical Cardiology, National Medical Research Center for Cardiology, Moscow, Russia