Acute Exacerbations of Chronic Lung Disease: Cardiac Considerations

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Abstract

The importance of appropriately recognizing and managing patients with cardiovascular and pulmonary comorbidities is underscored by the poor outcomes described in complex comorbid patients. Patients with chronic obstructive pulmonary disease (COPD) have an increased risk, up to one-third greater than the general population, of cardiovascular comorbidities including hypertension and diabetes [1].

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Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.

W. Q. Gan, S F P Man, A Senthilselvan … (2004)

Individuals with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular diseases, osteoporosis, and muscle wasting. Systemic inflammation may be involved in the pathogenesis of these disorders. A study was undertaken to determine whether systemic inflammation is present in stable COPD. A systematic review was conducted of studies which reported on the relationship between COPD, forced expiratory volume in 1 second (FEV(1)) or forced vital capacity (FVC), and levels of various systemic inflammatory markers: C-reactive protein (CRP), fibrinogen, leucocytes, tumour necrosis factor-alpha (TNF-alpha), and interleukins 6 and 8. Where possible the results were pooled together to produce a summary estimate using a random or fixed effects model. Fourteen original studies were identified. Overall, the standardised mean difference in the CRP level between COPD and control subjects was 0.53 units (95% confidence interval (CI) 0.34 to 0.72). The standardised mean difference in the fibrinogen level was 0.47 units (95% CI 0.29 to 0.65). Circulating leucocytes were also higher in COPD than in control subjects (standardised mean difference 0.44 units (95% CI 0.20 to 0.67)), as were serum TNF-alpha levels (standardised mean difference 0.59 units (95% CI 0.29 to 0.89)). Reduced lung function is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD.

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Mortality in COPD: Role of comorbidities.

D Sin, N R Anthonisen, J. Soriano … (2006)

Chronic obstructive pulmonary disease (COPD) represents an increasing burden throughout the world. COPD-related mortality is probably underestimated because of the difficulties associated with identifying the precise cause of death. Respiratory failure is considered the major cause of death in advanced COPD. Comorbidities such as cardiovascular disease and lung cancer are also major causes and, in mild-to-moderate COPD, are the leading causes of mortality. The links between COPD and these conditions are not fully understood. However, a link through the inflammation pathway has been suggested, as persistent low-grade pulmonary and systemic inflammation, both known risk factors for cardiovascular disease and cancer, are present in COPD independent of cigarette smoking. Lung-specific measurements, such as forced expiratory volume in one second (FEV(1)), predict mortality in COPD and in the general population. However, composite tools, such as health-status measurements (e.g. St George's Respiratory Questionnaire) and the BODE index, which incorporates Body mass index, lung function (airflow Obstruction), Dyspnoea and Exercise capacity, predict mortality better than FEV(1) alone. These multidimensional tools may be more valuable because, unlike predictive approaches based on single parameters, they can reflect the range of comorbidities and the complexity of underlying mechanisms associated with COPD. The current paper reviews the role of comorbidities in chronic obstructive pulmonary disease mortality, the putative underlying pathogenic link between chronic obstructive pulmonary disease and comorbid conditions (i.e. inflammation), and the tools used to predict chronic obstructive pulmonary disease mortality.

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Inflammatory markers and the risk of coronary heart disease in men and women.

Jennifer K Pai, Tobias Pischon, Jing Ma … (2004)

Few studies have simultaneously investigated the role of soluble tumor necrosis factor alpha (TNF-alpha) receptors types 1 and 2 (sTNF-R1 and sTNF-R2), C-reactive protein, and interleukin-6 as predictors of cardiovascular events. The value of these inflammatory markers as independent predictors remains controversial. We examined plasma levels of sTNF-R1, sTNF-R2, interleukin-6, and C-reactive protein as markers of risk for coronary heart disease among women participating in the Nurses' Health Study and men participating in the Health Professionals Follow-up Study in nested case-control analyses. Among participants who provided a blood sample and who were free of cardiovascular disease at baseline, 239 women and 265 men had a nonfatal myocardial infarction or fatal coronary heart disease during eight years and six years of follow-up, respectively. Using risk-set sampling, we selected controls in a 2:1 ratio with matching for age, smoking status, and date of blood sampling. After adjustment for matching factors, high levels of interleukin-6 and C-reactive protein were significantly related to an increased risk of coronary heart disease in both sexes, whereas high levels of soluble TNF-alpha receptors were significant only among women. Further adjustment for lipid and nonlipid factors attenuated all associations; only C-reactive protein levels remained significant. The relative risk among all participants was 1.79 for those with C-reactive protein levels of at least 3.0 mg per liter, as compared with those with levels of less than 1.0 mg per liter (95 percent confidence interval, 1.27 to 2.51; P for trend <0.001). Additional adjustment for the presence or absence of diabetes and hypertension moderately attenuated the relative risk to 1.68 (95 percent confidence interval, 1.18 to 2.38; P for trend = 0.008). Elevated levels of inflammatory markers, particularly C-reactive protein, indicate an increased risk of coronary heart disease. Although plasma lipid levels were more strongly associated with an increased risk than were inflammatory markers, the level of C-reactive protein remained a significant contributor to the prediction of coronary heart disease. Copyright 2004 Massachusetts Medical Society.

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Author and article information

Contributors

Surya P. Bhatt: sbhatt@uabmc.edu

Kate Milne: katemilne@alumni.ubc.ca

Don D. Sin: Don.Sin@hli.ubc.ca

Journal

Journal ID (publisher-id): 978-3-030-43435-9

Journal ID (doi): 10.1007/978-3-030-43435-9

Journal ID (nlm-ta): Cardiac Considerations in Chronic Lung Disease

Title: Cardiac Considerations in Chronic Lung Disease

ISBN (Print): 978-3-030-43434-2

ISBN (Electronic): 978-3-030-43435-9

Publication date (Electronic): 10 June 2020

Publication date Collection: 2020

Pages: 229-245

Affiliations

GRID grid.265892.2, ISNI 0000000106344187, Division of Pulmonary, Allergy and Critical Care Medicine, , University of Alabama at Birmingham, ; Birmingham, AL USA

GRID grid.416553.0, ISNI 0000 0000 8589 2327, University of British Columbia (UBC) Division of Respiratory Medicine (Department of Medicine) and Centre for Heart Lung Innovation, St. Paul’s Hospital, ; Vancouver, BC Canada

Article

Publisher ID: 12

DOI: 10.1007/978-3-030-43435-9_12

PMC ID: 7282481

SO-VID: 9061984a-9a9c-4dba-a8f2-0b190f8c5185

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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Keywords: chronic obstruction pulmonary disease (copd),acute exacerbation,ischemic heart disease,heart failure,atrial fibrillation,bnp,troponin

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Keywords: chronic obstruction pulmonary disease (copd), acute exacerbation, ischemic heart disease, heart failure, atrial fibrillation, bnp, troponin

Acute Exacerbations of Chronic Lung Disease: Cardiac Considerations

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Biomarkers for Inflammatory Lung Disease

Most cited references 58

Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.

Mortality in COPD: Role of comorbidities.

Inflammatory markers and the risk of coronary heart disease in men and women.

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