COPD的結果和心臟健康有關


  【24drs.com】新研究認為,慢性阻塞性肺部疾病(COPD)患者的心血管(CV)風險,可能有助於用來分類COPD病患的死亡率風險。
  
  加州大學爾灣分校心臟病預防計畫的Hwa Mu Lee醫師等人在4月19日的胸腔期刊線上發表一篇文章。
  
  為了評估心臟健康對COPD結果的影響,研究團隊評估了參加「全國健康及營養調查報告III (1988 - 1994)」6,266名40歲以上研究對象的資料,以及現有的肺功能計與CV風險因素資料。研究者使用了10年CV疾病風險分數(根據佛明罕心臟研究的風險計算模式)估計CV健康。
  
  整體而言,12.1%的研究對象有輕微COPD,8.7%為中度、1.7%為重度疾病。再者,研究者發現,沒有COPD者,CV事件(CVE)風險高的比率為25%,中度到重度COPD者的CV風險則是高達50%以上(P < .05)。
  
  低CV風險者,不論COPD嚴重度,死亡風險較低;當CV風險高時,死亡風險較高。不過,作者們發現,與CV風險分數較高的COPD病患相比,佛明罕心臟研究之10年風險評估分數低的中度到重度COPD者存活較久且較健康。
  
  因此,COPD病患中,若有CV風險則可顯著預測CVE和死亡率,預測效果優於肺功能檢測(CV風險和死亡率之P值都 < .0001)。
  
  根據加州大學爾灣分校的新聞稿,研究結果強調CV健康對COPD病患的重要性,強烈認為心臟病風險評估應納入肺氣腫和支氣管炎等肺部疾病的診斷與治療步驟。
  
  Lee醫師在新聞稿中指出,COPD和心臟病發作等CVEs之間有密切關聯,但是,醫師對COPD病患通常沒有將評估心臟病風險納入治療計畫內。
  
  研究者結論表示,整體風險分數明確且強烈,預測CVE和整體死亡率超出單純肺功能測量的COPD知識之上,就改善歧見來看,整體風險分數顯著增加了風險預測。
  
  這些研究結果的實務運用是,COPD病患有中或高CVE風險時,除了原本的COPD治療之外,或許還需要積極地及早開始降低CVE風險的治療,例如使用statin類藥物。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6807&x_classno=0&x_chkdelpoint=Y
  

COPD Outcomes Linked to Heart Health

By Emma Hitt, PhD
Medscape Medical News

May 3, 2012 — Cardiovascular (CV) risk in patients with chronic obstructive pulmonary disease (COPD) may be useful in stratifying patients with COPD for mortality risk, new research suggests.

Hwa Mu Lee, MD, from the Heart Disease Prevention Program at the University of California, Irvine, and colleagues report their findings in an article published online April 19 in Chest.

To assess the effect of heart health on COPD outcomes, the team evaluated data from 6266 adults aged 40 years or older who had participated in the National Health and Nutrition Examination Survey III (1988 - 1994) and for whom spirometry and CV risk factor data were available. The investigators used 10-year CV disease risk scores (estimated by the Framingham Heart Study's risk calculator) to estimate CV health.

Overall, 12.1% of the participants had mild COPD, whereas 8.7% had moderate and 1.7% had severe disease. Moreover, the researchers found that the proportion of individuals at high risk for CV events (CVEs) ranged from 25% in patients without COPD to more than 50% in those with moderate to severe COPD (P < .05).

Low CV risk predicted a lower death risk regardless of COPD severity; likewise, when CV risk was high, risk for death was higher. However, the authors found that individuals with moderate-to-severe COPD who had low Framingham Heart Study 10-year risk assessment scores lived longer and were healthier compared with similar patients with COPD who scored higher on CV risk.

Thus, in patients with COPD, the presence of CV risk significantly predicted CVE and mortality, above and beyond lung function measures (P < .0001 for both CV risk and mortality).

The findings highlight the benefits of CV health for patients with COPD and "strongly suggest that heart disease risk evaluations be part of the diagnostic and treatment procedures for lung diseases such as emphysema and bronchitis," according to a University of California, Irvine, news release.

"There is a close connection between COPD and [CVEs] like heart attacks, but too often physicians who see COPD patients do not assess the impact of heart disease risk factors as part of a treatment plan," Dr. Lee noted in the release.

"[G]lobal risk scores powerfully and significantly add to the prediction of CVE and total mortality over knowledge of COPD status from pulmonary function measurements alone, with global risk scores significantly adding to risk prediction from improvement in discrimination," the researchers conclude.

"The practical implications of the study findings are that patients with COPD at intermediate or high global CVE risk, in addition to their anti-COPD therapy, may require aggressive and early treatment of CVE risk reduction, such as statin therapy."

The study was not commercially supported. The authors have disclosed no relevant financial relationships.

Chest. Published online April 19, 2012.

    
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