title: Strategies for reducing the risk of cardiovascular disease in patients with chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by multimorbidities in affected patients. Even though the majority of these comorbidities are also related to advanced age and cigarette smoke, also COPD itself has significant impact on insurgence, or worsening of these conditions. As a consequence, COPD is regarded as a complex disease with pulmonary and extra-pulmonary involvement. According to current guidelines for the management of COPD patients, the comprehensive treatment of this condition should target respiratory symptoms as well as comorbidities. Cardiovascular disease is one of the most frequent comorbidities in COPD patients and there are several strategies for reducing the risk of cardiovascular disease in COPD patients. These include smoking cessation, pharmacologic prevention of cardiovascular disease, and the treatment of COPD. Beta-blockers for the prevention of cardiovascular disease have been traditionally limited in COPD patients, albeit current evidence supporting their efficacy and safety in these patients. With regard to COPD medications, corticosteroids are generally not recommended, except for exacerbations, while long-acting beta2-agonists have demonstrated an acceptable profile of cardiovascular safety. Long-acting anticholinergic bronchodilators, in particular tiotropium in the mist inhaler formulation, have been associated with an increased risk of major cardiovascular events and mortality. Data on this issue remain, however, controversial. Glycopyrronium, a recently introduced anticholinergic, demonstrated. a rapid and sustained relief of respiratory symptoms with a favorable safety profile and no increase in cardiovascular risk, in monotherapy and in combination with a long-acting beta2-agonist in a comprehensive trial program indicating a valid option for COPD patients with CV comorbidities.
authors: MeSVA Department, University of L'Aquila, Delta 6 Bldg, 67100, Coppito, L'Aquila, Italy, claudio.ferri@cc.univaq.it.
authors: Claudio
authors: C
authors: Ferri
mesh_terms: D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D015897:Comorbidity; D006801:Humans; D008019:Life Style; D018579:Patient Selection; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation
chemical_list: D001993:Bronchodilator Agents; D002317:Cardiovascular Agents
references: Chest. 2005 Oct;128(4):2068-75
references: 16236856
references: Am J Respir Crit Care Med. 2001 Apr;163(5):1256-76
references: 11316667
references: Multidiscip Respir Med. 2014 May 19;9(1):25
references: 25057359
references: Respirology. 2012 Apr;17(3):422-31
references: 22142519
references: Am J Respir Crit Care Med. 2009 Nov 15;180(10):948-55
references: 19729663
references: Respir Res. 2010 May 11;11:56
references: 20459831
references: PLoS One. 2014 Nov 26;9(11):e113048
references: 25427000
references: Heart. 2010 Oct;96(19):1525-30
references: 20736203
references: Respir Med. 2014 Oct;108(10):1498-507
references: 25135743
references: BMJ. 2013 Nov 22;347:f6650
references: 24270505
references: BMC Health Serv Res. 2012 Apr 03;12:89
references: 22471952
references: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566
references: 16235327
references: Int J Chron Obstruct Pulmon Dis. 2012;7:503-13
references: 22973092
references: Rev Med Suisse. 2005 Nov 16;1(41):2673-4, 2677-9
references: 16355882
references: Drugs. 2013 May;73(7):741-53
references: 23677802
references: Ann N Y Acad Sci. 2010 Aug;1203:66-72
references: 20716285
references: Am J Respir Crit Care Med. 2014 May 1;189(9):1022-30
references: 24552242
references: Respir Med. 2012 Nov;106(11):1487-93
references: 22902134
references: Am J Health Syst Pharm. 2010 Jul 1;67(13):1061-9
references: 20554591
references: BMC Pulm Med. 2014 Jan 17;14:4
references: 24438744
references: BMJ. 2011 Jun 14;342:d3215
references: 21672999
references: Ann Epidemiol. 2006 Jan;16(1):63-70
references: 16039877
references: JAMA. 2008 Sep 24;300(12):1439-50
references: 18812535
references: N Engl J Med. 2013 Oct 17;369(16):1491-501
references: 23992515
references: Thorax. 2010 Nov;65(11):956-62
references: 20871122
references: Int J Cardiol. 2011 Oct 6;152(1):88-94
references: 21397348
references: Clin Sci (Lond). 2014 Feb;126(4):267-74
references: 24144355
references: Nat Rev Cardiol. 2013 Apr;10(4):219-30
references: 23380975
references: Respir Med. 2011 Apr;105(4):571-9
references: 21227674
references: Curr Opin Pulm Med. 2007 Mar;13(2):90-7
references: 17255798
references: N Engl J Med. 2008 Oct 9;359(15):1543-54
references: 18836213
references: Int J Chron Obstruct Pulmon Dis. 2014 Aug 27;9:871-88
references: 25210449
references: Eur Respir J. 2012 Nov;40(5):1106-14
references: 23060624
references: Respir Res. 2011 Dec 07;12:156
references: 22151296
references: Thorax. 2010 Aug;65(8):719-25
references: 20685748
references: Respir Res. 2010 Sep 10;11:122
references: 20831787
references: Arterioscler Thromb Vasc Biol. 2014 Mar;34(3):509-15
references: 24554606
references: Lancet Respir Med. 2013 May;1(3):199-209
references: 24429126
references: Hypertension. 2005 Aug;46(2):273-9
references: 15983239
references: Eur Respir J. 2008 Oct;32(4):962-9
references: 18579551
references: Exp Diabetes Res. 2012;2012:271028
references: 22829804
references: Int J Chron Obstruct Pulmon Dis. 2014 Feb 24;9:215-28
references: 24596459
references: Chest. 2005 Jun;127(6):1952-9
references: 15947307