Impact of cancers and cardiovascular diseases in chronic obstructive pulmonary disease.

Cardiovascular disease and cancer are the two leading causes of morbidity and mortality in patients with chronic obstructive pulmonary disease. The epidemiological and mechanistic evidence linking these disorders, however, is uncertain. In patients with mild chronic obstructive pulmonary disease, cardiovascular disease accounts for nearly 50% of all hospitalizations and over 20% of all deaths, whereas lung cancer accounts for about a third of all mortality. Collectively, cancer is responsible for over 50% of all deaths in mild chronic obstructive pulmonary disease. In general, chronic obstructive pulmonary disease increases the risk of cardiovascular disease and lung cancer by two-fold, with increasing risk as the disease progresses. The mechanisms linking these disorders have not been well worked out. Shared genetic risk factors, and perturbations in the inflammatory, oxidative and neurohumoral responses, are implicated. Epidemiological studies suggest that anti-inflammatory drugs may reduce the risk of cardiovascular disease and lung cancer but have not been confirmed. Cardiovascular diseases and lung cancer are major sources of morbidity and mortality in chronic obstructive pulmonary disease. Patients should be assessed carefully for additional risk factors and be treated aggressively with interventions to mitigate the risk of cardiovascular disease and lung cancer.