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SC Cardiologia Clinica Riabilitativa Sarzana 1/33 db 7/5/2011 TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia.

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Presentation on theme: "SC Cardiologia Clinica Riabilitativa Sarzana 1/33 db 7/5/2011 TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia."— Presentation transcript:

1 SC Cardiologia Clinica Riabilitativa Sarzana 1/33 db 7/5/2011 TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia Ostruttiva Daniele Bertoli

2 SC Cardiologia Clinica Riabilitativa Sarzana 2/33 db 7/5/2011 COPD The 4 th leading cause of death in the USA (behind heart desease, cancer, cerebrovascular disease) In 1990, COPD was ranked 12 th 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

3 SC Cardiologia Clinica Riabilitativa Sarzana 3/33 db 7/5/2011

4 SC Cardiologia Clinica Riabilitativa Sarzana 4/33 db 7/5/2011 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 under- diagnosed, life-threatening lung disease.

5 SC Cardiologia Clinica Riabilitativa Sarzana 5/33 db 7/5/2011 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

6 SC Cardiologia Clinica Riabilitativa Sarzana 6/33 db 7/5/2011 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.

7 SC Cardiologia Clinica Riabilitativa Sarzana 7/33 db 7/5/2011 Spirometria Normale e Tracciato Spirometrico di Pazienti con BPCO

8 SC Cardiologia Clinica Riabilitativa Sarzana 8/33 db 7/5/2011 Classificazione spirometrica di gravità della BPCO basata sul VEMS post-broncodilatatore

9 SC Cardiologia Clinica Riabilitativa Sarzana 9/33 db 7/5/2011 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

10 SC Cardiologia Clinica Riabilitativa Sarzana 10/33 db 7/5/2011 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

11 SC Cardiologia Clinica Riabilitativa Sarzana 11/33 db 7/5/2011 The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the Literature Chest 2005;127;

12 SC Cardiologia Clinica Riabilitativa Sarzana 12/33 db 7/5/2011 The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the Literature Chest 2005;127;

13 SC Cardiologia Clinica Riabilitativa Sarzana 13/33 db 7/5/2011 Metaanalysis of studies that reported RR of cardiovascular mortality based on FEV1 quintiles. Chest 2005;127;

14 SC Cardiologia Clinica Riabilitativa Sarzana 14/33 db 7/5/2011 Metaanalysis of studies that reported RR of cardiovascular mortality among nonsmokers Chest 2005;127;

15 SC Cardiologia Clinica Riabilitativa Sarzana 15/33 db 7/5/2011 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):

16 SC Cardiologia Clinica Riabilitativa Sarzana 16/33 db 7/5/2011 Circulation 2003;107:

17 SC Cardiologia Clinica Riabilitativa Sarzana 17/33 db 7/5/2011 Circulation 2003;107:

18 SC Cardiologia Clinica Riabilitativa Sarzana 18/33 db 7/5/2011 Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis T horax 2004;59:574–580 Relationship between C-reactive protein (CRP) and COPD

19 SC Cardiologia Clinica Riabilitativa Sarzana 19/33 db 7/5/2011 Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis T horax 2004;59:574–580 Relationship between fibrinogen and COPD

20 SC Cardiologia Clinica Riabilitativa Sarzana 20/33 db 7/5/2011 Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis T horax 2004;59:574–580 Relationship between leucocytes and COPD

21 SC Cardiologia Clinica Riabilitativa Sarzana 21/33 db 7/5/2011 C-reactive Protein As a Predictor of Prognosis in Chronic Obstructive Pulmonary Disease Am J Respir Crit Care Med –255, 2007

22 SC Cardiologia Clinica Riabilitativa Sarzana 22/33 db 7/5/2011 COPD could be considered as part of a “chronic systemic inflammatory syndrome.” cardiovascular diseases lung cancer peripheral skeletal muscle dysfunction nutritional abnormalities osteoporosis increased prevalence of diabetes chronic kidney disease CHEST 2011; 139(1):165–173

23 SC Cardiologia Clinica Riabilitativa Sarzana 23/33 db 7/5/2011 Cardiovascular Safety of Tiotropium in Patients With COPD Chest 2010;137;20-30

24 SC Cardiologia Clinica Riabilitativa Sarzana 24/33 db 7/5/2011 Cardiovascular Safety of Tiotropium in Patients With COPD Chest 2010;137;20-30

25 SC Cardiologia Clinica Riabilitativa Sarzana 25/33 db 7/5/2011 J. Am. Coll. Cardiol. 2006;47; ;

26 SC Cardiologia Clinica Riabilitativa Sarzana 26/33 db 7/5/2011 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 ; 102 ( 2 ):

27 SC Cardiologia Clinica Riabilitativa Sarzana 27/33 db 7/5/2011

28 SC Cardiologia Clinica Riabilitativa Sarzana 28/33 db 7/5/2011 Beta-Blockers Patients with COPD are at increased risk of CAD, and ß- blockers 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 beta- blockers 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

29 SC Cardiologia Clinica Riabilitativa Sarzana 29/33 db 7/5/2011 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

30 SC Cardiologia Clinica Riabilitativa Sarzana 30/33 db 7/5/2011 Arch Intern Med. 2010;170(10):

31 SC Cardiologia Clinica Riabilitativa Sarzana 31/33 db 7/5/2011 Arch Intern Med. 2010;170(10):

32 SC Cardiologia Clinica Riabilitativa Sarzana 32/33 db 7/5/2011 Arch Intern Med. 2010;170(10):

33 SC Cardiologia Clinica Riabilitativa Sarzana 33/33 db 7/5/2011 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, beta- bloccanti, inibitori RAAS) sono efficaci anche nella BPCO

34 SC Cardiologia Clinica Riabilitativa Sarzana 34/33 db 7/5/2011 OSPEDALE SAN BARTOLOMEO DI SARZANA


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