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ChiesiPro | Kongress | European Respiratory Society | Latest insights on COPD and cardiovascular disease

Latest insights on COPD and cardiovascular disease

Summary of symposium
Clinical year in review – COPD and cardiovascular disease: latest insights in epidemiology, detection and intervention
Speakers: Borja Garcia-Cosio, Sami O. Simons, Bianca Beghè & Jennifer Quint.

ChiesiPro | Kongress | European Respiratory Society | Latest insights on COPD and cardiovascular disease
2024 ERS Wien
Forskning inom området kardiovaskulär sjukdom

On a scorching hot morning in Vienna, the Sunday session of ERS kick-started with a highly interesting discussion covering cardiovascular disease (CVD) in chronic obstructive pulmonary disease (COPD).

Co-occurring comorbidities in COPD
Individuals living with COPD often have several comorbidities. Prevalence of CVD in COPD is particularly high1 and is associated with an increased risk of death2. For example, COPD patients with mildly reduced ejection fraction have higher all-cause mortality than non-COPD patients with reduced ejection fraction3. Still, underdiagnosis of cardiovascular disease is high in patients with COPD.4

Every exacerbation matters

The association between CVD and COPD could be a consequence of shared risk factors (environmental and/or genetic factors), shared pathophysiological pathways, the co-occurrence of both diseases, and the adverse effects of COPD contributing to CVD, states Borja Garcia-Cosio. In clinical practice, controlling COPD is crucial, as a COPD exacerbation could trigger subsequent cardiovascular events. This risk remains elevated for up to a year after the exacerbation, and it intensifies with the severity of the episode5. Importantly, this increased risk is present even in patients who have not previously been diagnosed with CVD6. As Sami Simons stated: “Every exacerbation matters”.

If we do not look for it, we will never find it!

To address the underdiagnosis of CVD in COPD, early detection of CVD in COPD using a proactive search strategy is essential7. Several tools are available to determine CVD risk in the clinic8. For instance, CT thorax scans have been used to detect coronary artery calcification in COPD patients, which has been linked to increased dyspnea, reduced exercise capacity, and all-cause mortality9. Methods such as calculating risk scores with questionnaires, blood measurements (e.g., BNP, glucose, lipids), lung function testing, ECG, and echocardiogram also provide important clinical information that can identify individuals with high CVD risk and enable timely initiation of appropriate treatment says Bianca Beghè.

Addressing non-pharmacological or pharmacological

Treatment for COPD patients at risk of CVD may involve both non-pharmacological and pharmacological interventions. Jennifer Quint emphasizes the importance of non-pharmacological strategies, such as smoking cessation and physical activity, which have proven to be critical in reducing CVD risk.

Reduction in exacerbation and hospitalization risk, along with lung function improvement and better quality of life improvements has been demonstrated for triple therapy (ICS/LABA/LAMA)10-13, however impact on cardiovascular health and premature death still remains to be determined. Available post-hoc analysis14-16 of clinical trials have not been powered to demonstrate impact on all-cause mortality and since these studies are heterogenous and of explanatory nature, there is no clear evidence on all-cause mortality. However, Quint is optimistic that by combining real-world evidence with randomized controlled trials powered to address CVD risk and mortality, the evidence may become more robust in the future.

Shift in treatment

In clinical practice, a shift in perspective is needed when managing COPD patients. Improving diagnostic accuracy will require closer collaboration between pulmonologists and cardiologists, along with the development of holistic guidelines for managing multimorbidity in patients with complex chronic conditions. Early detection, phenotyping, and timely treatment are vital to reducing CVD risk in the COPD population.

Emil Bojsen-Møller
Medical Advisor, Chiesi Nordic

Biologics in COPD – are we there?
Publicerad: 18 mar 2024

Biologics in COPD – are we there?

Current status of biologics in COPD In Professor Alberto Papi’s comprehensive lecture on the evolving landscape of biological treatment in COPD, he emphasized the proven efficacy of triple therapy in … Läs mer

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