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)。
  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)。

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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