European Heart Journal Advance Access originally published online on October 11, 2005
European Heart Journal 2005 26(24):2743-2744; doi:10.1093/eurheartj/ehi594
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Heart failure in elderly patients with chronic obstructive pulmonary disease
Servicio de Cardiología
Complejo Hospitalario de Jaén
Pza del Zodiaco No.8, 5B
23009 Jaén
Spain
Tel: +34 637 463857
Fax: +34 953 270692
E-mail address: maapalomares{at}secardiologia.es
Servicio de Neumología
Hospital Universitario La Paz
Madrid
Spain
Servicio de Neumología
Hospital Universitario La Paz
Madrid
Spain
We read with great interest the article by Rutten et al.1 who report a significant association between the presence of chronic obstructive pulmonary disease and unrecognized heart failure in elderly patients. Approximately, 50% of heart failure patients in their study had isolated diastolic heart failure.
The authors suggested that the association between the two disorders may be attributable to the increased prevalence rates of atherosclerosis found in chronic obstructive pulmonary disease patients and the impressive smoking status of these patients. However, there is one other possible explanation for the high prevalence of heart failure in the chronic obstructive pulmonary disease in elderly patients. Some patients may have obstructive sleep apnoea (OSA). The possible presence of sleep-related disordered breathing was not ruled out in this study and it has been demonstrated that OSA can originate diastolic dysfunction independent of other factors.2 Indeed, the treatment of OSA among patients with congestive heart failure and left ventricular (LV) systolic dysfunction leads to improvement in cardiac function,3 suggesting that OSA may also have an adverse effect on LV systolic function.
The prevalence of OSA is not greater in chronic obstructive pulmonary disease patients than in the general population, but this association, the so-called overlap syndrome, is not rare, as chronic obstructive pulmonary disease and OSA are both frequently occurring diseases.4,5 In fact, OSA has a two- to three-fold higher prevalence in subjects older than 65 years when compared with those in middle age.6 Overlap patients are at a higher risk of developing respiratory insufficiency than are pure OSA patients. These facts could have contributed to overestimate the real prevalence of heart failure in ‘pure’ chronic obstructive pulmonary disease patients.
References
- Rutten FH, Cramer MJ, Grobbee DE et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005;26:1887–1894.
[Abstract/Free Full Text] - Arias MA, Garcia-Rio F, Alonso-Fernandez A et al. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 2005;112:375–383.
[Abstract/Free Full Text] - Kaneko Y, Floras JS, Usui K et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003;348: 1233–1241.
[Abstract/Free Full Text] - van Houwelingen KG, van Uffelen R, van Vliet AC. The sleep apnoea syndromes. Eur Heart J 1999;20:858–866.
[Free Full Text] - Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000;343:269–280.
[Free Full Text] - Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004;291:2013–2016.
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