¿La EPOC y sus exacerbaciones tienen un real impacto sobre la salud cardio y cerebrovascular?¿Este impacto es modificable?
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En Argentina, el tabaquismo causa más de 47.000 muertes anuales por cáncer, enfermedades cardiovasculares (ECV), enfermedad pulmonar obstructiva crónica (EPOC), neumonía y accidente cerebrovascular (ACV). Aproximadamente 7.000 personas mueren anualmente por EPOC en Argentina. Afecta al 14,5% de >40 años, con subdiagnóstico preocupante. Se realizó una revisión narrativa de las principales bases de datos científicos entre 1996 y 2025. El objetivo de este artículo es analizar las razones por las cuales la EPOC y sus exacerbaciones son factores de riesgo para ECV y ACV, y las estrategias preventivas que han disminuido riesgos.
Los pacientes con EPOC tienen mayor prevalencia de ECV y su severidad se correlaciona con mayor riesgo de muerte cardiovascular y general. Las infecciones respiratorias agudas, como influenza, virus sincicial respiratorio (VSR), SARS-CoV-2 y el Streptococcus pneumoniae, asociadas a las exacerbaciones de EPOC “per se”, aumentan significativamente el riesgo de eventos cardiovasculares y cerebrovasculares. Las exacerbaciones de EPOC incrementan drásticamente la morbimortalidad cardiovascular y cerebrovascular hasta un año después del evento.
Para prevenir el impacto cardio-cerebrovascular en pacientes con EPOC, son cruciales varias intervenciones. La cesación tabáquica es la más costo-efectiva, reduciendo la mortalidad. La rehabilitación respiratoria y la actividad física regular mejoran la salud y disminuyen la mortalidad general, cardiovascular y respiratoria. La vacunación contra influenza y neumococo reducen el riesgo de eventos cardiovasculares mayores y mortalidad. Finalmente, la triple terapia inhalada en pacientes EPOC exacerbadores con > 300 eosinófilos/ul reduce la mortalidad y eventos cardiovasculares.
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