Management of the patient with COPD and cardiovascular disease
- Imre Noth, MD
Imre Noth, MD
- Professor of Medicine in Pulmonary and Critical Care
- University of Chicago School of Medicine
- Gregory A Schmidt, MD
Gregory A Schmidt, MD
- Professor of Medicine, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine
- University of Iowa
- Section Editors
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
- Deputy Editors
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
- Gordon M Saperia, MD, FACC
Gordon M Saperia, MD, FACC
- Senior Deputy Editor — UpToDate
- Deputy Editor — Cardiovascular Medicine
- Assistant Professor of Medicine
- Tufts University School of Medicine
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), which includes coronary heart disease, peripheral artery disease, and cerebrovascular disease, share tobacco abuse as a major risk factor. Thus, these two disorders commonly coexist. In addition, CVD is a leading cause of death among patients with COPD.
The management of patients with concurrent COPD and CVD will be reviewed here. The diagnosis and management of COPD and coronary heart disease occurring independently are discussed separately. (See "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging" and "Management of stable chronic obstructive pulmonary disease" and "Management of exacerbations of chronic obstructive pulmonary disease" and "Stable ischemic heart disease: Overview of care" and "Epidemiology of coronary heart disease" and "Screening for coronary heart disease".)
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, and the presence of one can affect outcomes in the other . As symptoms can overlap, differentiating the relative contributions of these diseases to a given patient’s symptoms can be challenging.
Coexistence of COPD and CVD — The frequent coexistence of COPD and CVD has been observed in several studies [2-4]. As an example, a study from a large United Kingdom database of more than 1.2 million patients over age 35 identified almost 30,000 patients with COPD; these patients were nearly five times more likely to have cardiovascular disease than those without COPD . In a separate study of 351 patients with advanced COPD, clinically significant coronary disease was identified by angiography in 60 percent and was occult in 53 percent . In a meta-analysis, patients with COPD were more likely to be diagnosed with cardiovascular disease (OR 2.46; 95% CI 2.02-3.00) than patients without COPD . The cardiovascular diseases included ischemic heart disease, cardiac dysrhythmia, heart failure, diseases of the pulmonary circulation, and diseases of the systemic arteries.
Impact of co-morbid disease on outcomes — A large number of observational studies have found that the coexistence of COPD and cardiovascular disease has an important impact on clinical outcomes.
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- COPD/CVD RELATIONSHIP
- Coexistence of COPD and CVD
- Impact of co-morbid disease on outcomes
- EVALUATION AND DIAGNOSIS OF CHD IN PATIENTS WITH COPD
- Myocardial ischemia
- Heart failure
- NONPHARMACOLOGIC THERAPIES
- Smoking cessation
- Cardiopulmonary rehabilitation
- Management of hypoxemia
- - Effect of hypoxemia on the heart
- - Indications for supplemental oxygen
- Noninvasive positive pressure ventilation
- TREATMENT OF COPD IN PATIENTS WITH CVD
- Inhaled anticholinergic medications
- Beta-2 agonists
- - Short-acting beta agonists
- - Long-acting beta agonists
- Combination inhaled bronchodilator plus glucocorticoid
- TREATMENT OF CVD IN PATIENTS WITH COPD
- Effects of beta-blockers on mortality and COPD exacerbations
- Effect of cardioselective beta blockers on lung function
- Effect of combination beta and alpha blockers on lung function
- Effect of statins on COPD exacerbations
- Revascularization in patients with COPD
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS