Cardiovascular Complications of COPD

Answer: E. Both C and D are correct

Discussion

Heart disease is the leading cause of death in patients with COPD when respiratory failure is excluded. ¹ In fact, patients with COPD are at increased risk for atherosclerotic events independent of their age, gender, or smoking history. ¹ In patients with COPD, the use of long acting beta-agonists has not been shown to increase the risk for MI.^2,3 Furthermore, inhaled glucocorticoids have been shown to be safe in patients who are otherwise at increased risk for cardiovascular disease.⁴ Thus, options A and B are incorrect.

COPD itself is associated with increased systemic inflammation, which contributes to the pathogenesis of coronary atherosclerosis. ¹ Recent studies have shown that platelet reactivity is increased during acute exacerbations of COPD, even if patients are taking antiplatelet agents.¹ Thus, the best answer is option E.

References

1. Muñoz-Esquerre M, Ferreiro JL, Huertas D, et al. Impact of acute exacerbations on platelet reactivity in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis. 2018;13:141-148.
2. Ferguson GT, Funck-Brentano C, Fischer T, Darken P, Reisner C. Cardiovascular safety of salmeterol in COPD. Chest. 2003;123(6):1817-1824.
3. Tranfa CM, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G. Short-term cardiovascular effects of salmeterol. Chest. 1998;113(5):1272-1276.
4. Calverley PM, Anderson JA, Celli B, et al; for the TORCH Investigators. Cardiovascular events in patients with COPD: TORCH study results. Thorax. 2010;65(8):719-725.