The association between chronic obstructive bronchopathy (COPD) and cardiovascular disease has been known for quite a long time. Even with equal smoking, a patient suffering from COPD has more cardiovascular comorbidities than a subject who has not developed COPD. We are talking about cardiopulmonary risk. “The pathophysiology of this association remains poorly understood. It is probably complex but it is a safe bet that the chronic inflammation associated with COPD plays a part in it,” explains Professor Maeva Zysman (Bordeaux University Hospital). More recently, we noticed that cardiovascular events were particularly increased in the year following an exacerbation of COPD. Several studies have confirmed this in 2024.
A peak within 30 days
These studies show that after an exacerbation, patients have more cardiovascular events in the following year. These events are particularly common in the 30 days after an exacerbation, even more in the week following. “And this increase in cardiovascular events is found not only after severe exacerbations requiring hospitalization but also after moderate exacerbations managed at home with corticosteroids and/or antibiotics,” insists the specialist.
Many of these events — heart failure decompensations, myocardial infarction, atrial fibrillation, strokes, transient ischemic attacks, lower limb ischemia, etc. — are serious.
French data based on PMSI analysis showed that 10% of cardiovascular events post-exacerbation of COPD requiring hospitalization lead to death (1).
These same French data also show that the more severe the COPD exacerbation, the greater the risk of cardiovascular events. Patients who had an exacerbation of BCPO treated in a medical department had a two-fold increased risk of subsequent cardiovascular events. When those whose exacerbation required hospitalization in intensive care or intensive care had a risk of subsequent cardiovascular events multiplied by seven. In addition, this increased risk seems relatively independent of the context. It is found regardless of gender and age, although older men are particularly affected.
Think about “cardiopulmonary risk” and screen
Growing awareness of this “cardiopulmonary risk” led cardiologists this year to include COPD in the estimation of an individual’s cardiovascular risk. This year, the new definition of Q-RISK version 4, published in Nature Medicine (2) has in fact integrated seven new factors, including the presence of COPD. As a result, this new score predicts the risk of cardiovascular events at ten years much better than the old one in the validation cohorts.
“For their part, pulmonologists and cardiologists are considering, together, useful examinations to detect a cardiac problem in a COPD patient and, conversely, to detect a pulmonary problem in a patient with cardiovascular disease,” explains Professor Zysman. French and Canadian experts should soon publish their recommendations. “The idea is to initiate basic common sense clinical examinations. Namely, systematically check a COPD patient for hypertension, dyslipidemia, diabetes and perform an ECG. And think reciprocally about doing spirometry on a heart patient. Without hesitating, if necessary, to refer your patient to a cardiologist and/or a pulmonologist,” she concludes.
According to an interview with Professor Maeva Zysman (Bordeaux University Hospital)
(1) M. Zysman et al. Exacerbations of chronic obstructive pulmonary disease and cardiovascular events: descriptive analyzes of PMSI data. Rev Mal Respir News 2024;16:27
(2) J Hippisley-Cox et al. Development and validation of a new algorithm for improved cardiovascular risk prediction. Nature Medicine 2024 ; 30:1440-7
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