Acknowledging the syndemic: a real-life cohort study of major adverse cardiovascular events in COPD

Extract COPD patients have a high risk of major adverse cardiovascular events (MACE). Hence, COPD and cardiovascular disease may benefit from a syndemic approach. The association between COPD and cardiovascular disease is partially due to shared risk factors such as smoking, ageing, sedentary lifestyle, and shared comorbidities [1, 2]. In addition, COPD itself is an independent risk factor for cardiovascular disease. Indeed, when matched for the established cardiovascular risk factors, COPD patients have a 25% higher risk of MACE compared to smokers without COPD [3]. This can be partly explained by systemic inflammation and oxidative stress associated with COPD. Moreover, hyperinflation and hypoxia may increase pulmonary vascular resistance, causing right ventricular dysfunction and increase risk of MACE [4, 5]. Recent COPD GOLD guidelines introduced blood eosinophil count (BEC) as a possible theragnostic biomarker [6]. Because of their link with type 2 inflammation, blood eosinophils can contribute to the development of cardiovascular disease [7, 8]. Neurohumoral activation, which is well recognised in cardiovascular disease and particularly in heart failure, may also contribute to the increased cardiovascular risk observed in COPD patients [9]. Considering the clinical relevance of MACE prevention, this study aimed to identify clinical characteristics associated with MACE in a tertiary care COPD population.