Cardiovascular comorbidities in patients with chronic obstructive pulmonary disease in exacerbation

Abstract

Cardiovascular comorbidities (CVCs) in patients with chronic obstructive pulmonary disease (COPD) are important causes of morbidity and mortality, with a noticeable economic impact on public health systems. Currently, COPD is one of the top three causes of death in the world; in 2019, it caused 3.23 million deaths. Nearly 90% of deaths of COPD patients are attested in low- and middle-income people under 70. At the level of the person, the disease manifests itself through suffering, but also through substantial socio-economic costs, and at the macroeconomic level – through very high costs. In the EU, COPD is the leading cause of morbidity and mortality from respiratory disease, accounting for 8% of deaths of people affected by respiratory diseases [1, 2, 3]. In the Republic of Moldova, according to statistical data, in 2017, with J 44 code, 138.9 cases per 10,000 adult population were registered [4]. According to data published in recent years, the prevalence of cardiovascular disease (CVD) is obviously increased in patients with COPD: prevalence of heart failure – 4 times; prevalence of ischemic heart disease – 2 times; prevalence of myocardial infarction – 2.5 times; prevalence of peripheral arterial diseases and arrhythmias – 2.4 times; prevalence of strokes – by 1.4 [5]. Description of the situation in the field of research and identification of research problems Cardiovascular disease, concomitant with COPD, is seen in the context of a "cardiopulmonary continuum". The mechanisms linking COPD and cardiovascular pathology are unclear. However, the presence of common risk factors and chronic systemic inflammation is considered one of the mechanisms. Systemic inflammation, present during exacerbation of COPD, provides a potential mechanism to explain the increased risk of associated cardiovascular events [6]. In the international context of continuous increase in the number of patients with chronic respiratory diseases and CVD, a study assessing the incidence of these diseases among the population of the Republic of Moldova is of real use for the purpose of guiding public health policies and dimensioning the necessary effort at the level of the health system in the management of these diseases. They are not rigorous CVC identification and management systems in COPD, validated for widespread use. Methods to quantify the weight of CVC should be part of a multidimensional assessment of the severity of COPD, as CVC can have varying complexity and impact across the population by age, gender, ethnicity and etiology; they need to be adapted, adjusted, used correctly in the stratification of the risk of death, appropriate diagnosis. Thus, it is necessary to conduct a complex population study, accompanied by some applicative value assessments in several approaches of COPD: GOLD classification, groups A, B, C, D, multidimensional indices at group level, in order to develop new diagnostic strategies, prognosis for CVC and to develop validated models for estimating the impact of CVC in the evolution of COPD. The purpose of the study: Evaluation of cardiovascular comorbidities in patients with chronic obstructive pulmonary disease, in exacerbation, and development, improvement of the Algorithm for early diagnosis of the risk of cardiovascular complications in patients with COPD.