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New insights on link between common lung diseases and cardiovascular risk

Deepak L. Bhatt

Patients with common lung diseases, including asthma, chronic obstructive pulmonary disease and lung fibrosis, are significantly more likely to develop cardiovascular disease, according to a study published in the Journal of the American College of Cardiology.

“The cardiovascular diseases which we found in these respiratory patients are serious and not only have a large impact on patients’ day-to-day lives but also have high mortality rates. These mortality rates are compounded by having both heart and lung conditions. For example, COPD and fibrosis patients were on average 60% more likely to die after developing heart failure than those with heart failure but no lung disease,” Rahul Potluri, MBChB, founder of the ACALM Study Unit and clinical lecturer at Aston Medical School in Birmingham, England, said in a press release.

The study, which evaluated more than 1 million patients in the ACALM database in England from 2000 to 2013, identified 31,646 patients with COPD, 60,424 with asthma and 1,662 with interstitial lung disease. Control groups comprised 158,230 patients with COPD, 302,120 with asthma and 8,310 interstitial lung disease, with a total follow-up of 2,968,182 patient-years.

Results demonstrated independent associations between COPD and increased likelihood for ischemic heart disease, HF, atrial fibrillation and peripheral vascular disease; asthma and increased likelihood for ischemic heart disease; and interstitial lung disease and increased likelihood for ischemic heart disease and HF. CV conditions also contributed to an increased risk for death.

“The most striking findings were that when compared to patients without lung disease, risk of ischemic heart disease was increased by 50% in asthmatics, 60% in fibrosis and 75% in COPD. Similarly, the risk of HF, which is a serious chronic condition [that] happens when the heart struggles to pump enough blood around the body, was a massive 2.2-fold greater in COPD and fibrosis patients,” Paul Carter, MBChB, from the University of Cambridge, said in the release.

Patients with vs. without lung disease were also less likely to receive coronary revascularization via percutaneous coronary intervention or coronary artery bypass graft surgery, but revascularization was associated with a lower risk for death, according to the data.

The researchers highlighted several study limitations, including its observational cohort design and the potential for residual confounding. They also noted that most patients with COPD and asthma are treated in outpatient settings, but the study data were restricted to hospitalized patients. Information on antihypertensives, lipid-lowering therapy, smoking cessation efforts and the type of HF was also unavailable.

“Our findings provide novel understanding about the cardiovascular diseases suffered by patients with chronic lung diseases. We now need to investigate the scientific reasons underlying these findings, and one potential mechanism is chronic inflammation,” Deepak L. Bhatt, MD, professor of medicine at Harvard Medical School and executive director of interventional cardiovascular programs in the Heart and Vascular Center at Brigham and Women’s Hospital, said in the release. – by Melissa Foster

Disclosures: Carter and Potluri report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.