Chest
Translating Basic Research into Clinical PracticeCardiovascular Disease in COPD: Mechanisms
Section snippets
Traditional Risk Factors
Smoking is the causative factor in the majority of individuals with COPD and is a causative factor in the development of coronary artery disease. It is, therefore, difficult to show in a COPD population that the increased risk of cardiovascular disease is due to COPD alone because COPD and smoking are inextricably linked. It is also very difficult to correct for cigarette smoke exposure statistically in studies. It seems likely, then, that cigarette smoke plays an important role in the
Systemic Inflammation
It is well recognized that COPD is associated with not only pulmonary but also systemic inflammation. In a systematic review of 14 original studies, Gan and coworkers7 demonstrated that levels of systemic inflammatory markers, including blood leukocyte count, C-reactive protein (CRP), IL-6, and fibrinogen, were elevated in patients with COPD compared with smoking control subjects. This systemic inflammation increases with disease severity8 and is associated with increased mortality.9 It has
Future Directions
Research examining the mechanisms of cardiovascular disease in COPD is at an early stage. Although COPD is associated with a number of measures of cardiovascular risk and associated with mediators of cardiovascular disease, atherosclerosis, and thrombosis, it is still unclear whether these markers play a specific role in the pathogenesis or are epiphenomena. Although we are closer to uncovering the causative mechanisms for cardiovascular disease in COPD, more work is required to elucidate these.
Conclusion
A number of putative mechanisms have been proposed that link coronary heart disease and COPD (Fig 1). Further elucidation of these mechanisms should provide novel targets for treatment of both the lung and the cardiovascular manifestations of COPD.
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Prof MacNee has acted in an advisory capacity for GlaxoSmithKline plc; Pfizer, Inc; Novartis AG; and Almirall, SA. He has received payment from GlaxoSmithKline plc and Pfizer, Inc, for research programs and clinical activities and has received payments from Boehringer Ingelheim GmbH, GlaxoSmithKline plc, AstraZeneca, Novartis AG, and Janssen Pharmaceuticals, Inc, to travel to meetings and
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