What is it about?

The role of antiplatelet therapy (APT) using aspirin and ticagrelor in the primary prevention of cardiovascular disease among COPD patients has not been evaluated previously. The aim of this early-phase trial is to evaluate the effect of antiplatelet therapy (aspirin, ticagrelor) on platelet function and explore its effect on the inflammatory markers in patients with COPD with no prior history of CAD.

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Why is it important?

Chronic obstructive pulmonary disease (COPD) is a significant global health burden and is in the world's top three global killers. The major cause of COPD is smoking and there is an excess of cardiovascular disease seen in COPD patients as compared to those matched for smoking exposure without COPD. The prevalence of coronary artery disease (CAD) in COPD patients has been estimated at 10–38% with 20–50% of mortality in COPD being related to cardiovascular causes. The ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) observational cohort study showed that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

Perspectives

Several mechanisms have been proposed to explain the increased risk of CAD in COPD patients. Spill-over of pulmonary inflammation to the systemic circulation has been proposed as a possible mechanism. Another proposed mechanism contributing to CAD in COPD is an increased in vivo platelet activation state, which plays a key role in the pathogenesis of atherothrombosis. Monocyte–platelet aggregates, a marker of platelet activation, are elevated in both patients with stable and acute exacerbation of COPD.

Vijay Kunadian
Newcastle University

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This page is a summary of: Antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease: a randomised controlled proof-of-concept trial, ERJ Open Research, July 2019, European Respiratory Society (ERS),
DOI: 10.1183/23120541.00110-2019.
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