It’s always said: COPD seems to be a systemic disease although others say that it is a lung disease with systemic consecuences. Furthermore, many specialists agree in this being a manifestation of smoking effects that will be found with comorbidities. But in the meantime… where are we in the understanding of the cardiovascular effects of COPD.
Reasearch in the field of CV events and COPD
A recent correspondance sent by Alain Boussuges and Marion Gouitaa from Marseille, France to the AJRCCM (Am J Resp Crit Care Med 2008 Apri 15;177(8):929; author reply 929-30) opened the forum for more discussion about this topic. Boussuges and Goiutaa commented their personal experience where COPD patients showed increased periferal arterial stiffness when compared with healthy patients. These changes in arterial compliance were clearly correlated with COPD stages.
This comment was also based on a previous article by Ramsey Sabit and coleagues from UK (Am J Respir Crit Care Med 2007;175:1259–1265). Sabit assessed arterial stiffness and osteoporosis in COPD in 75 subjects with different degrees of COPD. This assessment was guided based on the typical association between an increased risk of cardiovascular events and COPD as well as this with osteoporosis.
Arterial Stiffness as a effect of COPD?
Sabit found that COPD severity was in close relation with increased arterial stiffness which may be a key factor in the development of the excess risk for cardiovascular disease in COPD.
How is it possible that they occur together?
As part of the reasons responsible for this association, Boussuges and Gouitaab pointed out the coincidence of many physiological consequences in COPD. For example, the excess sympathetic tone (activation) due to “Hypoxia, systemic inflammation, and obstruction of the bronchi” could lead to the impairment of the arterial compliance with vascular smooth muscle activation and subsequent stiffness.
Although the association or order of events has not been clearly established, the fingers are signaling to where everything starts: Smoking as way to activate the sympathetic system as well as inducing the reaction in the bronchi.
More complicated than expected
COPD is a manifestation and cardiovascular events are there, growing and growing in number in these patients. COPD is a lung disease with many comorbidities that need to be addressed during therapy. Many factors need to be addressed during the COPD treatment.