COPD & HF

People with COPD have an increased risk of major cardiovascular events (myocardial infarction, stroke, sudden death, acute heart failure, pulmonary embolism). In addition, the outcome of patients with ischemic heart disease is influenced dramatically by COPD with an increased risk of heart failure, particularly in people between 40 and 64 years (4 times).

The treatment of COPD patients with ischemic heart disease with or without heart failure requires a combined approach for the high cardiovascular risk. That includes smoking cessation, cardio-respiratory rehabilitation, oxygen therapy (if indicated) and maximal therapy with statins and inhibitors of SRAA. The latter two categories of drugs in combination are effective in improving outcomes of COPD.

The use of beta-blockers should be pursued and should seek the maximum tolerated dose of carvedilol or bisoprolol in patients with no reversibility of airway obstruction and reversibility in the case of bisoprolol. The use of selective beta-1 is effective (if and when tolerated) is useful to mitigate the adverse effects of drugs described beta-stimulants (increased heart failure and death) in these patients with ischemic heart disease and COPD.

Unfortunately, the anticholinergic drugs that seemed to promise comparable efficacy to beta-stimulants with fewer unpleasant events in a recent meta-analysis showed an increased risk of major cardiovascular events in people with COPD.

The high cardiovascular risk in patients with COPD, COPD dangerous association with myocardial infarction and heart failure, and the complex interactions of the drugs make treatment of these patients extremely difficult. Never as in this case as well as useful guidelines should keep in mind that there are sick people and not diseases.