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The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by\xa0student Dr. Adriana Mares, answered first by early career preventive cardiologist\xa0Dr. Dipika Gopal, and then by expert faculty Dr. Michael Wesley Milks.\n\nDr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council.\n\nThe CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the\xa0ACC Prevention of CVD Section, the\xa0National Lipid Association, and\xa0Preventive Cardiovascular Nurses Association.\n\nQuestion #7\n\nWhile you are on holiday break visiting your family, your aunt pulls you aside during the family gathering to ask a few questions about your 70-year-old uncle. He has hypertension, hyperlipidemia, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease. His medications include Fluticasone/Salmeterol, Tiotropium, Albuterol, Lisinopril, Simvastatin, and Metformin. She is very concerned about his risk for heart disease as he has never had his \u201cheart checked out.\u201d She asks if the presence of COPD increases his chance of having heart disease. Which of the following statements would best answer her question?\n\nA. Systemic inflammation and oxidative stress caused by COPD promote vascular remodeling and a paradoxical \u2018anticoagulant\u2019 state affecting all vasculature types.\nB. Although chronic COPD is associated with increased cardiovascular events, individual exacerbations have no impact on risk of cardiovascular events.\nC. Patients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure.\nD. Cardiovascular mortality increases proportionally with an increase in forced expiratory volume in 1 second (FEV1)\n\nAnswer #7\n\nThe correct answer is C. \n\nPatients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure. Patients with COPD have a 2-3-fold increased risk of CV events compared to age-matched controls even when adjusted for tobacco smoking, a shared risk factor. This can be partly explained by other common risk factors including aging, hypertension, hyperlipidemia, and low physical activity.\n\nInterestingly, CVD mortality increases proportionally with a decrease (rather than increase) in FEV1, making answer choice D wrong (28% increase CVD mortality for every 10% decrease in FEV1). Additionally, COPD exacerbations and related infections are associated with a 4x increase in CVD events, making answer choice B incorrect.\n\nCOPD has several effects on the vasculature which creates a \u2018procoagulant\u2019 not \u2018anticoagulant\u2019 effect on all vascular beds. This is associated with increased risk of cognitive impairment due to cerebral microvascular damage as well as increased risk of ischemic and hemorrhagic stroke.\n\nMain Takeaway\n\nThe presence of COPD (even mild to moderate) has a significant impact on the incidence of non-fatal coronary events, stroke, and cardiovascular mortality mediated by inherent disease process and progression, risk factors (smoking, aging, hypertension, and hyperlipidemia), and systemic inflammation altering vasculature creating a \u2018procoagulant\u2019 effect. The ESC gives a Class I indication (LOE C) to investigate for ASCVD and ASCVD risk factors in patients with COPD.\n\nGuideline Location\n\n3.4.5, Page 3264.\n\n\n\nCardioNerds Decipher the Guidelines - 2021 ESC Prevention Series\nCardioNerds Episode Page\nCardioNerds Academy\nCardionerds Healy Honor Roll\n\nCardioNerds Journal Club\nSubscribe to The Heartbeat Newsletter!\nCheck out CardioNerds SWAG!\nBecome a CardioNerds Patron!