Update zu COPD und kardiovaskulären Ereignissen

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Koexistenz von COPD und Herz-Kreislauf-Erkrankungen

COPD (chronisch-obstruktive Lungenerkrankung) ist eng mit kardiovaskulären Erkrankungen assoziiert. Koexistieren COPD und Herz-Kreislauf-Erkrankungen, steigen Hospitalisierungsrate, Symptomlast, die Gefahr schwerer kardiovaskulärer Ereignisse sowie die Gesamtmortalität an.

Kardiovaskuläres Risiko und COPD-Exazerbation

Das Risiko kardiovaskulärer Ereignisse steigt während und kurze Zeit nach einer Exazerbation an. Schwere Exazerbationen stellen das höchste Risiko bezüglich kardiovaskulärer Ereignisse dar.

Pathophysiologische Überlegungen

Die Mechanismen, die beide Krankheitskomplexe verbinden, sind komplex und schließen eine systemische Entzündung, oxidativen Stress, endotheliale Dysfunktion, autonome Dysregulation und Hypoxämie mit ein.

Kardiovaskuläres Risiko und COPD-Medikamente

COPD-Patienten sollen leitliniengerecht therapiert werden. In Bezug auf das kardiovaskuläre Risikoprofil gibt es keine zu bevorzugende Therapiekombination.

Handlungsempfehlungen für Diagnostik und Therapie

Ein frühes Screening und die konsequente Einstellung kardiovaskulärer Risikofaktoren sind von zentraler Bedeutung. Die leitliniengerechte Behandlung der COPD hat einen positiven Effekt auf kardiovaskuläre Endpunkte. Auch die Behandlung von kardiovaskulären Erkrankungen mit Statinen, Betablockern und ggf. SGLT-2-Hemmern kann positive Auswirkungen auf den Verlauf einer COPD haben. Akute Exazerbationen einer COPD (AEOPD) sind während der Erkrankung und danach mit einem deutlich erhöhten kardiovaskulären Risiko assoziiert, sodass die davon betroffenen Patienten diesbezüglich evaluiert werden sollten.

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is closely linked to cardiovascular disease (CVD), with up to 70% of COPD patients experiencing cardiovascular comorbidities. The coexistence of COPD and CVD significantly increases hospitalization rates, symptom burden, and mortality, particularly during acute exacerbations of COPD (AECOPD), which impose an increased risk of cardiovascular events – both during and shortly after these episodes. Mechanistic links between COPD and CVD include systemic inflammation, oxidative stress, endothelial dysfunction, and hypoxemia, all of which contribute to the progression of both conditions.

Current management guidelines stress the importance of early screening and risk factor control for cardiovascular comorbidities in COPD patients. Different COPD therapies can affect cardiovascular outcomes in distinct ways. Recent research suggests that inhaled corticosteroids (ICS), either alone or as part of triple therapy (long-acting muscarinic antagonist [LAMA], long-acting beta-agonist [LABA], and ICS), may help reduce mortality and morbidity, particularly for those at higher risk. Furthermore, beta-blockers and statins have shown potential benefits for COPD patients with CVD, although their exact role is not entirely clear. Newer antidiabetic agents, such as SGLT-2 inhibitors, have also demonstrated promise in reducing exacerbation rates.

This review emphasizes the need for an integrated care approach, highlighting the importance of personalized, guideline-driven therapies to enhance quality of life and clinical outcomes for COPD patients with cardiovascular comorbidities.

Schlüsselwörter

chronisch-obstruktive Lungenerkrankung - kardiovaskuläre Erkrankungen - COPD-Exazerbation - Pathophysiologie - COPD-Medikamente

Keywords

chronic obstructive pulmonary disease - cardiovascular diseases - COPD exacerbation - pathophysiology - COPD medication

Publication History

Article published online:
21 February 2025

• Literatur

• 1 Polman R, Hurst JR, Uysal OF. et al. Cardiovascular disease and risk in COPD: a state of the art review. Expert Rev Cardiovasc Ther 2024; 22: 177-191
• 2 Balbirsingh V, Mohammed AS, Turner AM. et al. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax 2022;
• 3 Labaki WW, Gu T, Murray S. et al. Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment. Am J Respir Crit Care Med 2023; 208: 451-460
• 4 Maclagan LC, Croxford R, Chu A. et al. Quantifying COPD as a risk factor for cardiac disease in a primary prevention cohort. Eur Respir J 2023; 62: 2202364
• 5 Liu X, Chen Z, Li S. et al. Association of Chronic Obstructive Pulmonary Disease With Arrhythmia Risks: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8: 732349
• 6 Simons SO, Elliott A, Sastry M. et al. Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective. Eur Heart J 2021; 42: 532-540
• 7 Müllerova H, Marshall J, de Nigris E. et al. Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16: 17534666221113647
• 8 Daniels K, Lanes S, Tave A. et al. Risk of Death and Cardiovascular Events Following an Exacerbation of COPD: The EXACOS-CV US Study. Int J Chron Obstruct Pulmon Dis 2024; 19: 225-241
• 9 Maeda T, Dransfield MT. Chronic obstructive pulmonary disease and cardiovascular disease: mechanistic links and implications for practice. Curr Opin Pulm Med 2024; 30: 141-149
• 10 Dransfield MT, Criner GJ, Halpin DMG. et al. Time-Dependent Risk of Cardiovascular Events Following an Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Post Hoc Analysis From the IMPACT Trial. J Am Heart Assoc 2022; 11: e024350
• 11 Bhatt SP, Nanda S, Kintzer JS. Arrhythmias as trigger for acute exacerbations of chronic obstructive pulmonary disease. Respir Med 2012; 106: 1134-1138
• 12 Yang M, Li Y, Jiang Y. et al. Combination therapy with long-acting bronchodilators and the risk of major adverse cardiovascular events in patients with COPD: a systematic review and meta-analysis. Eur Respir J 2023; 61: 2200302
• 13 Rebordosa C, Plana E, Rubino A. et al. Risk Assessment of Acute Myocardial Infarction and Stroke Associated with Long-Acting Muscarinic Antagonists, Alone or in Combination, versus Long-Acting beta2-Agonists. Int J Chron Obstruct Pulmon Dis 2022; 17: 1715-1733
• 14 Chen CY, Pan SW, Hsu CC. et al. Comparative cardiovascular safety of LABA/LAMA FDC versus LABA/ICS FDC in patients with chronic obstructive pulmonary disease: a population-based cohort study with a target trial emulation framework. Respir Res 2023; 24: 239
• 15 Singh D, Martinez FJ, Hurst JR. et al. Effect of Triple Therapy on Cardiovascular and Severe Cardiopulmonary Events in COPD: A Post-hoc Analysis of a Randomized, Double-Blind, Phase 3 Clinical Trial (ETHOS). Am J Respir Crit Care Med 2024;
• 16 Pradhan R, Lu S, Yin H. et al. Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study. BMJ 2022; 379: e071380