Avaliação da prevalência e das repercussões clínicas da associação entre doença pulmonar obstrutiva crônica e doença coronariana crônica
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Data
2016-02-26
Autores
Coelho, Liana Sousa [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A associação entre Doença Pulmonar Obstrutiva Crônica (DPOC) e Doença Arterial Coronariana (DAC) é importante causa de morbidade e mortalidade em pacientes com DPOC. Dados da literatura mostram que essa associação ocorre independente de fatores de risco comuns – tabagismo, idade e gênero e que o processo inflamatório pode ser o elo entre essas doenças. Além disso, a presença de comorbidades pode alterar de forma significativa a gravidade da DPOC e/ou DAC. O presente estudo tem como objetivos avaliar a prevalência da associação entre DPOC e DAC em pacientes com diagnóstico primário de uma das doenças e avaliar as características gerais dos pacientes com DPOC, DAC e ambas as doenças. Além disso, avaliar intensidade da dispneia, tolerância ao exercício, qualidade de vida, estado inflamatório e achados ecocardiográficos em cada grupo de pacientes. Foram avaliados 95 pacientes, de ambos os gêneros e idade ≥ 40 anos. Destes, 43 foram diagnosticados com DPOC, 47 com DAC e 5 com ambas as doenças. Todos foram submetidos a avaliação clínica, eletrocardiograma, ecocardiograma, radiograma de tórax, avaliação da composição corporal, teste de caminhada de 6 minutos (DP6), exames laboratoriais, espirometria e responderam aos questionários de qualidade de vida. A prevalência de DAC em DPOC foi de 10,4%, enquanto que no grupo de pacientes com DAC a prevalência de DPOC foi de 9,6% e, quando avaliados DAC tabagistas, foi de 17,2%. O grupo DPOC apresentou maior percepção de dispneia (p<0,001), menor DP6 (p=0,037), pior qualidade de vida, avaliada pelo SF-36 (p<0,001) e aumento da proteína C-reativa (PCR) (p=0,020) em comparação com grupo DAC. Regressão linear não identificou correlação entre o estado inflamatório avaliada por PCR e IL-6 à presença de DAC (p=0,992 e p=0,978, respectivamente). Em nosso estudo, a prevalência de DAC em DPOC assemelhou-se aos menores valores encontrados na literatura. Pacientes com ambas as doenças apresentaram maior intensidade de dispneia, pior qualidade de vida e maior estado inflamatório que os outros grupos. Não encontramos relação entre o estado inflamatório e a prevalência de DAC em DPOC; esta associação parece dever-se à alta prevalência dos fatores de risco clássicos para DAC nos pacientes com DPOC.
The association between Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with COPD. Published data show that this association is independent of common risk factors - smoking, age and gender, and that the inflammatory process may be a link between these diseases. Furthermore, the comorbidities can significantly alter the severity of COPD and/or CAD. This study aims to evaluate the prevalence of the association between COPD and CAD in patients with a primary diagnosis of a disease and assessing the general characteristics of patients with COPD, CAD and both diseases. Also, to assess the severity of dyspnea, exercise tolerance, health status, inflammatory status, echocardiographic findings in each group of patients. We evaluated 95 patients of both genders and age ≥ 40 years-old. Of these, 43 were diagnosed with COPD, 47 with CAD and 5 with both diseases. All patients underwent clinical evaluation, electrocardiogram, echocardiogram, chest X-ray, assessment of body composition, 6-minute walk test, laboratory tests, spirometry and answered all health status’ questionnaires. The prevalence of CAD in COPD was 10.4% while in patients with CAD, the prevalence of COPD was 9.6%, and in DAC with smoking history, the prevalence was 17.2%. The COPD group had a higher perception of dyspnea (p<0.001), lower 6-minute walking distance (6MWD) (p=0.037), worse health status assessed by the SF-36 (p<0.001) and increased C-reactive protein (CRP) (p=0.020) compared to CAD group. Linear regression did not identify correlation between inflammatory status, assessed neither by CRP nor by IL-6, and the presence of CAD (p 0.992 and p 0.978, respectively). In our study, the prevalence of CAD in COPD resembles the lower values found in the literature. Patients with both diseases presented more intense dyspnea, lower exercise tolerance, worse health status and higher inflammatory status than other groups. There was no relationship between inflammatory status and the prevalence of CAD in COPD; this association is probably due to the high prevalence of classic risk factors for CAD in patients with COPD.
The association between Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with COPD. Published data show that this association is independent of common risk factors - smoking, age and gender, and that the inflammatory process may be a link between these diseases. Furthermore, the comorbidities can significantly alter the severity of COPD and/or CAD. This study aims to evaluate the prevalence of the association between COPD and CAD in patients with a primary diagnosis of a disease and assessing the general characteristics of patients with COPD, CAD and both diseases. Also, to assess the severity of dyspnea, exercise tolerance, health status, inflammatory status, echocardiographic findings in each group of patients. We evaluated 95 patients of both genders and age ≥ 40 years-old. Of these, 43 were diagnosed with COPD, 47 with CAD and 5 with both diseases. All patients underwent clinical evaluation, electrocardiogram, echocardiogram, chest X-ray, assessment of body composition, 6-minute walk test, laboratory tests, spirometry and answered all health status’ questionnaires. The prevalence of CAD in COPD was 10.4% while in patients with CAD, the prevalence of COPD was 9.6%, and in DAC with smoking history, the prevalence was 17.2%. The COPD group had a higher perception of dyspnea (p<0.001), lower 6-minute walking distance (6MWD) (p=0.037), worse health status assessed by the SF-36 (p<0.001) and increased C-reactive protein (CRP) (p=0.020) compared to CAD group. Linear regression did not identify correlation between inflammatory status, assessed neither by CRP nor by IL-6, and the presence of CAD (p 0.992 and p 0.978, respectively). In our study, the prevalence of CAD in COPD resembles the lower values found in the literature. Patients with both diseases presented more intense dyspnea, lower exercise tolerance, worse health status and higher inflammatory status than other groups. There was no relationship between inflammatory status and the prevalence of CAD in COPD; this association is probably due to the high prevalence of classic risk factors for CAD in patients with COPD.
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Palavras-chave
DPOC, Doença arterial coronariana, Capacidade de exercício, Qualidade de vida, Inflamação sistêmica, Coronary artery disease, Exercise capacity, Health status, Systemic inflammation