TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia

SC Cardiologia Clinica RiabilitativaSarzana

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TERZA SESSIONEL’ANZIANO CARDIOPATICO CON

CO-MORBILITÀ

Infarto miocardico e Broncopneumopatia

Ostruttiva

Daniele Bertoli

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• The 4th leading cause of death in the USA (behind heart desease, cancer, cerebrovascular disease)

• In 1990, COPD was ranked 12th as a burden of disease; by 2020 it is projected to rank 5°

• The majority of patients with COPD die from cardiovascular disorders or cancer, not respiratory disease

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COPD: Definition

• lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

• The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs.

• The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis.

• COPD is not simply a "smoker's cough" but an under-diagnosed, life-threatening lung disease.

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COPD: Definition• diagnosis is confirmed by spirometry• COPD should be considered in any patient

who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease

• Chronic cough and sputum production often precede the development of airflow limitation by many years, although not all individuals with cough and sputum production go on to develop COPD

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PARAMETRI SPIROMETRICI

• FEV1 o VEMS (Volume espiratorio forzato in 1 secondo) = quantità di aria emessa nel primo secondo di espirazione forzata

• FVC (Capacità Vitale Forzata) = quantità massima di aria (misurata in litri) che può essere espulsa in un’espirazione forzata dopo un’ispirazione completa.

• FEV1/FVC = Un valore inferiore al 70% indica un deficit ostruttivo e alta probabilità di BPCO.

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Spirometria Normale e TracciatoSpirometrico di Pazienti con BPCO

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Classificazione spirometrica di gravitàdella BPCO basata sul VEMS

post-broncodilatatore

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Heart disease and COPD

• The most common cardiac abnormalities in patients with COPD are cor pulmonale and pulmonary hypertension

• The prevalence of atrial fibrillation, atherosclerosis, and CHF is also high among patients with COPD

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Atherosclerosis and COPD

• Although some of the association between COPD and atherosclerosis may be the result of common risk factors such as tobacco use, epidemiological evidence suggests that impaired lung function is a risk factor for increased cardiovascular death independent of tobacco use

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The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the LiteratureChest 2005;127;1952-1959

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The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the LiteratureChest 2005;127;1952-1959

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Metaanalysis of studies that reported RR of cardiovascular mortality based on FEV1 quintiles.

Chest 2005;127;1952-1959

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Metaanalysis of studies that reported RR of cardiovascular mortality among nonsmokers

Chest 2005;127;1952-1959

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Relationship between FEV 1, smoking status, and OR for cardiovascular mortality for current smoker (dark grey squares), ex-smoker (white

squares), and never smoker (light grey squares)

Young RP , Hopkins R , Eaton TE . Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes . Eur Respir J . 2007; 30(4): 616- 622

16/33db 7/5/2011Circulation 2003;107:1514-1519

17/33db 7/5/2011Circulation 2003;107:1514-1519

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Association between chronic obstructive pulmonary diseaseand systemic inflammation: a systematic review and a metaanalysis Thorax 2004;59:574–580

Relationship between C-reactive protein (CRP) and COPD

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Relationship between fibrinogen and COPD

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Relationship between leucocytes and COPD

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C-reactive Protein As a Predictor of Prognosis in ChronicObstructive Pulmonary Disease

Am J Respir Crit Care Med 175. 250–255, 2007

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COPD could be considered as part of a “chronic systemic inflammatory syndrome.”• cardiovascular diseases

• lung cancer

• peripheral skeletal muscle dysfunction

• nutritional abnormalities

• osteoporosis

• increased prevalence of diabetes

• chronic kidney diseaseCHEST 2011; 139(1):165–173

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Cardiovascular Safety of Tiotropium in Patients With COPD

Chest 2010;137;20-30

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Cardiovascular Safety of Tiotropium in Patients With COPD

Chest 2010;137;20-30

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J. Am. Coll. Cardiol. 2006;47;2554-2560;

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Long-term mortality according to COPD and statin use in patients with peripheral arterial disease

van Gestel YR , Hoeks SE , Sin DD , et al . Effect of statin therapy on mortality in patients with peripheral arterial disease and comparison of those with versus without associated chronic obstructive pulmonary disease . Am J Cardiol . 2008 ; 102 ( 2 ): 192 - 196

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Beta-Blockers• Patients with COPD are at increased risk of CAD, and ß-

blockers play a pivotal role in the management of cardiovascular diseases.

• There is a general reluctance to use these substances in patients with COPD because of an unfounded fear of inducing bronchospasm.

• A large Cochrane review revealed that cardioselective beta-blockers did not adversely affect the FEV1 or induce respiratory symptoms compared with placebo, independent of the severity of the COPD.

• Given the demonstrated efficacy of b -blockers in treating CAD and CHF, the benefit of these medicaments outweighs the side effects and they should not be withheld from patients with COPD

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Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis

of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

European Journal of Heart Failure (2009) 11, 292–298

30/33db 7/5/2011Arch Intern Med. 2010;170(10):880-887

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Take Home Messages

• La BPCO è un fattore di rischio cardiovascolare

• E’ probabile che meccanismi fisiopatologici simili, di tipo infiammatorio, siano presenti nella BPCO e nella malattia aterosclerotica

• Le terapie pneumologiche più efficaci (tiotropio in particolare) sono efficaci anche per ridurre il rischio CV dei pazienti con BPCO

• Le terapie cardiologiche più efficaci (statine, beta-bloccanti, inibitori RAAS) sono efficaci anche nella BPCO

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OSPEDALE SAN BARTOLOMEO DI SARZANA

TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia

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