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Coronary artery disease is under-diagnosed and under-treated in advanced lung disease
Robert M Reed1, Michael Eberlein, Reda E Girgis
1Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. rreed@medicine.umaryland.edu
Insights
Coronary artery disease is common in advanced lung disease patients but often under-diagnosed. Guideline-recommended heart medications are underused in this population, highlighting a need for better management strategies.
Area of Science:
- Cardiology
- Pulmonology
- Medical Comorbidities
Background:
- Coronary artery disease (CAD) is a frequent, treatable comorbidity in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).
- The prevalence of angiographically proven CAD in advanced lung disease is not well-characterized.
- Understanding CAD treatment patterns and occult disease frequency in this population is crucial.
Purpose of the Study:
- To characterize CAD treatment patterns in patients with advanced lung disease (COPD or ILD).
- To determine the frequency of occult CAD in patients with advanced lung disease.
- To compare CAD prevalence and treatment between COPD and ILD patients.
Main Methods:
- Retrospective, 2-center cross-sectional study of 473 patients with COPD or ILD undergoing lung transplant evaluation.
- Recorded pre-transplant medications and diagnoses.
- Analyzed left heart catheterization results for CAD detection.
Main Results:
- CAD was present in 60% of patients undergoing angiography, with 16% having severe CAD.
- Occult CAD was found in 53% of patients, and severe occult CAD in 9%.
- Beta-blocker use was significantly lower in COPD patients (23%) compared to ILD patients (58%).
Conclusions:
- CAD is highly prevalent and frequently under-diagnosed in advanced lung disease (COPD/ILD).
- Suboptimal utilization of guideline-recommended cardioprotective medications was observed.
- Further research and improved clinical practice are needed for managing CAD in advanced lung disease.
Background:
Coronary artery disease is a potentially treatable comorbidity observed frequently in both chronic obstructive pulmonary disease and interstitial lung disease. The prevalence of angiographically proven coronary artery disease in advanced lung disease is not well described. We sought to characterize the treatment patterns of coronary artery disease complicating advanced lung disease and to describe the frequency of occult coronary artery disease in this population.
Methods:
We performed a 2-center, retrospective cross-sectional study of patients with either chronic obstructive pulmonary disease or interstitial lung disease evaluated for lung transplantation. Medications and diagnoses before the transplant evaluation were recorded in conjunction with left heart catheterization results.
Results:
Of 473 subjects, 351 had chronic obstructive pulmonary disease, and 122 had interstitial lung disease. In subjects diagnosed clinically with coronary artery disease, medical regimens included a statin in 78%, antiplatelet therapy in 62%, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in 42%, and a beta-blocker in 37%. Ten percent were on no medication from these 4 classes. Fifty-seven percent of these subjects were on an antiplatelet agent as well as a statin, and 13% were on neither. Beta-blockers were less frequently prescribed in chronic obstructive pulmonary disease than interstitial lung disease (23% vs 58%, P=.007). Coronary angiography was available in 322 subjects. It demonstrated coronary artery disease in 60% of subjects, and severe coronary artery disease in 16%. Occult coronary artery disease and severe occult coronary artery disease were found in 53% and 9%, respectively. There were no significant differences in angiographic results between chronic obstructive pulmonary disease and interstitial lung disease, despite imbalanced risk factors.
Conclusions:
Coronary artery disease is common in patients with advanced lung disease attributable to chronic obstructive pulmonary disease or interstitial lung disease and is under-diagnosed. Guideline-recommended cardioprotective medications are suboptimally utilized in this population.
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