Exacerbating the burden of cardiovascular disease: how can we address cardiopulmonary risk in individuals with chronic obstructive pulmonary disease?

Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) often co-exist. 1,2This is not surprising given their shared risk factors including, but not limited to, smoking, hypertension, dyslipidaemias, atrial fibrillation, physical inactivity, and air pollution.Evidence from the EURObservational Research Programme Heart Failure Long-Term Registry showed that prevalence of diagnosed COPD amongst individuals admitted with heart failure may be up to 19%, based on analysis of 6920 individuals hospitalized with heart failure. 1 Similarly, there is a reciprocal association with CVD in individuals with COPD.Data from the Julius General Practitioners' Network, a collaboration of nearly 70 general practices in the Netherlands with ∼370 000 registered patients, demonstrated a 3-fold increased incidence of heart failure and 1.7-fold increased incidence of ischaemic heart disease in individuals with COPD. 2 In reality, these figures are likely to be underestimated because in the UK alone, reports estimate that there could be up to 2 million individuals with undiagnosed COPD, 3 suggesting that many patients with potentially high CVD risk remain undetected and untreated.In individuals with coexisting CVD and COPD, the risk of adverse clinical events is increased above that of each comorbidity in isolation.Mortality risk among those with both conditions is increased by up to 90% compared with those who have COPD alone, 4 and approximately one-third of all COPD deaths could be cardiovascular in origin.It is well documented that acute exacerbations of COPD (AECOPDs) accelerate lung function decline and increase the risk of further acute events and premature mortality.An AECOPD also increases the risk of major