Overviewof the pharmacological challenges facing physicians in themanagement of patients with concomitant cardiovascular disease and chronic obstructive pulmonary disease

Abstract

Cardiovascular disease (CVD), including ischaemic heart disease (IHD) and heart failure (HF), and chronic obstructive pulmonary disease (COPD) are often concomitant because they share both risk factors (smoke) and pathological pathways (systemic inflammation). Cardiovascular disease andCOPDassociation is increasing overtime. Several registries clearly showed a negative impact on the clinical outcome of the concomitant presence of CVD andCOPD. Patients with CVD and COPD present an increased risk for myocardial infarction, HF, and hospital admission for acute exacerbation ofCOPD, with a negative impact on prognosis. To reduce the effect of this negative association, it is of paramount importance the pharmacological treatment with both cardiovascular and respiratory drugs, according to current guidelines. Nevertheless, several registries and studies showed that evidence-based drugs (both cardiovascular and respiratory) are often under administered in this subset of patients. In this overview, we summarize the available data regarding the use of cardiovascular drugs (antiplatelet agents, angiotensin converting enzyme inhibitors,b-blockers, and statins) inCOPDpatients, with or without concomitant IHD. Furthermore,we report advantages and disadvantages of respiratory drugs (b2 agonists, anti-cholinergics, and corticosteroids) administration in COPD patients with CVD.