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Increased Adverse Events After Percutaneous Coronary Intervention in Patients With COPDPercutaneous Coronary Intervention in COPD FREE TO VIEW

Robert M. Reed, MD; Steven Scharf, MD, PhD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine.

Correspondence to: Robert M. Reed, MD, University of Maryland Physicians, Division of Pulmonary and Critical Care Medicine, 110 S Paca St, 2nd Floor, Baltimore, MD 21201; e-mail: rreed@medicine.umaryland.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):828-829. doi:10.1378/chest.11-2613
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To the Editor:

In reference to the recent article by Enriquez et al1 (September 2011), we commend the authors for highlighting the problem of significantly lower rates of β-blocker and statin therapy given to patients with COPD. This finding suggests that patients with COPD may be undertreated for concomitant cardiovascular disease. In a similar vein, we previously reported on statin therapy in subjects undergoing evaluation for lung transplantation in whom pulmonary hemodynamic data were available and found that only 67% of subjects with angiographically proven severe coronary disease (CAD) were receiving statin therapy prior to evaluation.2 Applying a more liberal definition of CAD to include any degree of angiographically observed coronary disease, only 42% of the patients used statin therapy. Patients using β-blockers found to have severe vs any CAD on angiography was very low at 11% and 5%, respectively.

It has been demonstrated that COPD is associated with excess cardiovascular disease even after controlling for potential confounders, such as tobacco exposure.3,5 These studies, however, are not able to account for treatment differences, which could significantly affect the observed associations. The study by Enriquez et al1 has implications applicable both clinically and for future research design. Clinically, physicians should work to challenge the misperception that β-blockers are contraindicated in COPD. Data clearly show that cardioselective β-blockers are well tolerated in COPD5,6 and should not be withheld for this reason. The disparity of statin prescription is somewhat perplexing and perhaps explained by the observation of favorable lipid profiles, which may be associated with COPD.7 In terms of future research design, it is clearly imperative that studies of CAD in COPD take into consideration the possible confounding effect of potentially inadequate cardioprotective regimens given to these patients.

Enriquez JR, Parikh SV, Selzer F, et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute Dynamic Registry. Chest. 2011;1403:604-610. [PubMed] [CrossRef]
 
Reed RM, Iacono A, DeFilippis A, et al. Statin therapy is associated with decreased pulmonary vascular pressures in severe COPD. COPD. 2011;82:96-102. [PubMed]
 
Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337-349. [PubMed]
 
Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation. 2001;10422:2679-2684. [PubMed]
 
Kotlyar E, Keogh AM, Macdonald PS, Arnold RH, McCaffrey DJ, Glanville AR. Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma. J Heart Lung Transplant. 2002;2112:1290-1295. [PubMed]
 
Gold MR, Dec GW, Cocca-Spofford D, Thompson BT. Esmolol and ventilatory function in cardiac patients with COPD. Chest. 1991;1005:1215-1218. [PubMed]
 
Reed RM, Iacono A, Defilippis A, Eberlein M, Girgis RE, Jones S. Advanced chronic obstructive pulmonary disease is associated with high levels of high-density lipoprotein cholesterol. J Heart Lung Transplant. 2011;306:674-678. [PubMed]
 

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References

Enriquez JR, Parikh SV, Selzer F, et al. Increased adverse events after percutaneous coronary intervention in patients with COPD: insights from the National Heart, Lung, and Blood Institute Dynamic Registry. Chest. 2011;1403:604-610. [PubMed] [CrossRef]
 
Reed RM, Iacono A, DeFilippis A, et al. Statin therapy is associated with decreased pulmonary vascular pressures in severe COPD. COPD. 2011;82:96-102. [PubMed]
 
Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337-349. [PubMed]
 
Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation. 2001;10422:2679-2684. [PubMed]
 
Kotlyar E, Keogh AM, Macdonald PS, Arnold RH, McCaffrey DJ, Glanville AR. Tolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma. J Heart Lung Transplant. 2002;2112:1290-1295. [PubMed]
 
Gold MR, Dec GW, Cocca-Spofford D, Thompson BT. Esmolol and ventilatory function in cardiac patients with COPD. Chest. 1991;1005:1215-1218. [PubMed]
 
Reed RM, Iacono A, Defilippis A, Eberlein M, Girgis RE, Jones S. Advanced chronic obstructive pulmonary disease is associated with high levels of high-density lipoprotein cholesterol. J Heart Lung Transplant. 2011;306:674-678. [PubMed]
 
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