TERZA SESSIONE
L’ANZIANO CARDIOPATICO CON
CO-MORBILITÀ
Infarto miocardico e
Broncopneumopatia
Ostruttiva
Daniele Bertoli
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COPD
• 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 underdiagnosed, 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 Tracciato
Spirometrico di Pazienti con BPCO
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Classificazione spirometrica di gravità
della 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 Literature
Chest 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 Literature
Chest 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
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Circulation 2003;107:1514-1519
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Circulation 2003;107:1514-1519
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Association between chronic obstructive pulmonary disease
and 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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Association between chronic obstructive pulmonary disease
and systemic inflammation: a systematic review and a
metaanalysis
Thorax 2004;59:574–580
Relationship between fibrinogen and COPD
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Association between chronic obstructive pulmonary disease
and systemic inflammation: a systematic review and a
metaanalysis
Thorax 2004;59:574–580
Relationship between leucocytes and COPD
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C-reactive Protein As a Predictor of Prognosis in Chronic
Obstructive 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.”
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•
•
•
•
•
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cardiovascular diseases
lung cancer
peripheral skeletal muscle dysfunction
nutritional abnormalities
osteoporosis
increased prevalence of diabetes
chronic kidney disease
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CHEST 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 ßblockers 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 betablockers 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
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Arch 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, betabloccanti, inibitori RAAS) sono efficaci anche
nella BPCO
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OSPEDALE SAN BARTOLOMEO DI SARZANA
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