The impact of comorbid cardiovascular pathology and triple inhalation therapy on outcomes in patients with chronic obstructive pulmonary disease: a review of current evidence

The article describes the pathophysiological ground of the relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs), the prevalence and prognostic significance of this comorbidity, as well as the optimal treatment of concomitant CVD and COPD. A review of the current literature is provided, including the results of large cohort, observational studies and meta-analyses on the epidemiology, pathophysiological mechanisms, clinical outcomes, and specific features of the treatment of concomitant CVD and COPD. It is shown that the prevalence of CVD in patients with COPD is 25–70%, which is 2–5 times higher than in the general population. It was found that the pathophysiological relationship between COPD and CVD is due to smoking, age, sex, and other common risk factors, as well as systemic inflammation, oxidative stress, endothelial dysfunction, hypoxemia, activation of the sympathetic nervous system, and pulmonary hyperinflation. Modern triple inhalation therapy (long-acting anticholinergics/long-acting â2-agonists/inhaled glucocorticosteroids) has demonstrated advantages over dual therapy (long-acting â2-agonists/long-acting anticholinergics) in reducing overall mortality (hazard ratio 0.66–0.76) as well as the risk of acute cardiovascular events and cardiovascular mortality (hazard ratio 0.52–0.455). It is concluded that the optimization of inhalation therapy, in particular the administration of triple therapy to patients at high risk of COPD exacerbations, contributes not only to improving COPD control, but also to reducing cardiovascular risks and mortality.