The Global Working Group on Cardiopulmonary Risk in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. It is a leading cause of morbidity and mortality globally, often complicated by cardiovascular diseases (CVD), which substantially contribute to adverse outcomes in chronic obstructive pulmonary disease.1 Patients with chronic obstructive pulmonary disease not only have elevated cardiovascular risk, but frequently have co-existent CVD, develop incident CVD as a result of chronic obstructive pulmonary disease, and die from CVD. Numerous studies have highlighted the elevated risk of CVD in chronic obstructive pulmonary disease.2 The Global Working Group on Cardiopulmonary Risk in chronic obstructive pulmonary disease was established in December 2023 to address this3—fostering research, clinical approaches, and collaboration—to improve the care and outcomes for people with chronic obstructive pulmonary disease. Cardiopulmonary events include moderate or severe chronic obstructive pulmonary disease exacerbation, myocardial infarction, stroke, heart failure event, cardiac arrhythmia, or death due to any of these events.4 Cardiopulmonary risk is a patient’s risk of experiencing a cardiopulmonary event, and is modifiable. However, once a patient with chronic obstructive pulmonary disease has been optimally managed in terms of their cardiovascular and pulmonary disease and risk, they may continue to be at elevated cardiopulmonary risk, albeit with a lower risk of events—termed residual cardiopulmonary risk. The mission of the Global Working Group on Cardiopulmonary Risk in chronic obstructive pulmonary disease is to improve the care and outcomes of individuals with chronic obstructive pulmonary disease by addressing cardiopulmonary risk. There are four objectives of the Global Working Group on Cardiopulmonary Risk in chronic obstructive pulmonary disease. These are to: Improve clinical strategies for the management of cardiopulmonary risk and events in chronic obstructive pulmonary disease; Advocate for patients about cardiopulmonary risk and events in chronic obstructive pulmonary disease; Promote education among healthcare professionals about cardiopulmonary risk and events in chronic obstructive pulmonary disease; and Encourage original research about cardiopulmonary risk and events in chronic obstructive pulmonary disease. The Global Working Group employs a multidisciplinary approach, integrating expertise from pulmonologists, cardiologists, specialist nurses, general practitioners, cardiorespiratory physiologists, pharmacists, epidemiologists, health economists, public health professionals, medical students, and patients. Since its inception, at which point it comprised 12 members, the Global Working Group has grown to now include 125 people representing 45 countries (Figure 1). We extend membership to people from these disciplines who are committed to advancing the understanding and management of cardiopulmonary risk and events in chronic obstructive pulmonary disease. Inquiries may be directed to the corresponding author. Choropleth of the number of members of the Global Working Group on Cardiopulmonary Risk per participating country The Global Working Group on Cardiopulmonary Risk is an established international collaboration which will continue to expand and deliver new insights and information to improve the care and outcomes of people with chronic obstructive pulmonary disease. There are many gaps in our knowledge of how to best manage this patient population, and through collaborative research, we can generate the evidence needed. Illustrations of how the Global Working Group’s objectives may be realized include improving the identification and treatment of cardiovascular risk and CVD in chronic obstructive pulmonary disease. Recent evidence shows that cardiovascular risk scoring for the prevention of CVD underestimates risk in chronic obstructive pulmonary disease,5 and that this may be addressed by incorporating chronic obstructive pulmonary disease and/or chronic obstructive pulmonary disease severity into risk scores.6 Identifying cardiovascular risk in people with chronic obstructive pulmonary disease will allow its quantification and mitigation though lifestyle and pharmacological interventions. For example, intensification of lipid-lowering therapy may be appropriate in those at high calculated risk of myocardial infarction and stroke. This is important because there is evidence that people with chronic obstructive pulmonary disease who have CVD risk factors less frequently achieve CVD-related therapeutic targets. Moreover, there is an argument for current CVD risk factor targets to be modified for chronic obstructive pulmonary disease, akin to other high-risk CVD states such as diabetes and chronic kidney disease. Earlier diagnosis of chronic obstructive pulmonary disease allows pulmonary (and cardiovascular) interventions to be initiated earlier in the disease course to improve outcomes.7 People with chronic obstructive pulmonary disease frequently have co-existent CVD, and this manifests as hypertension, ischaemic heart disease, atrial fibrillation, and heart failure—detecting and optimally treating CVD in people with chronic obstructive pulmonary disease is likely to improve their outcomes. To that end, the management of CVD in people with chronic obstructive pulmonary disease should follow established guidelines for the respective CVD. In addition, algorithms and associated clinical protocols should be developed to identify cardiopulmonary risk in chronic obstructive pulmonary disease so that care may be personalized and delivered efficiently at scale. In contrast to the European Society of Cardiology Clinical Practice Guidelines, that discuss chronic obstructive pulmonary disease in CVD, there is a paucity of information about the management of CVD in chronic obstructive pulmonary disease in international respiratory guidelines. Moreover, to date, there is no specific guidance or recommendation for the identification and management of cardiopulmonary events and risk in chronic obstructive pulmonary disease—the Global Working Group is addressing this, and will advocate for information about managing CVD to be represented in respiratory guidelines. Providing education about cardiopulmonary risk to all involved in the care of patients with chronic obstructive pulmonary disease will afford a skilled workforce more capable of addressing cardiopulmonary risk. The fostering of local, regional, and international collaboration between healthcare professionals in chronic obstructive pulmonary disease and cardiology is essential to develop and disseminate best practices for managing chronic obstructive pulmonary disease patients with concurrent CVD. Promoting research about cardiopulmonary risk and events in chronic obstructive pulmonary disease is essential—given the knowledge gaps in this area.3 The Global Working Group encourages original research about cardiopulmonary risk and events, and aims to undertake original research such as systematic and narrative reviews, prospective studies, retrospective health records studies, quality improvement initiatives, as well as provide consensus and Delphi process statements. These data will lay the groundwork for future randomized trials of interventions aimed at reducing cardiopulmonary risk in chronic obstructive pulmonary disease. Despite the increased cardiovascular risk associated with chronic obstructive pulmonary disease, CVD in this population remains under-recognized, under-diagnosed, and undertreated. Equally, chronic obstructive pulmonary disease may be under-appreciated and sub-optimally managed in people with CVD. As such, there exist missed opportunities to reduce the risk of adverse cardiovascular and respiratory events—‘cardiopulmonary risk’—in these populations. The Global Working Group on Cardiopulmonary Risk in chronic obstructive pulmonary disease is a new international and interdisciplinary collaborative that aims to address the interdependent challenges of chronic obstructive pulmonary disease and CVD. Through new clinical approaches, research, education, and advocacy, the Group aims to improve the quality of life and health outcomes for chronic obstructive pulmonary disease patients worldwide. Continued global collaboration and innovation are essential to advance this. C.P.G. conceived the original idea and produced the first draft of the manuscript. D.D.B. and M.B. contributed to the content and format of the article, and provided critical feedback, and helped shape the final manuscript. C.P.G. declares grants or contracts from Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb, and European Society of Cardiology; consulting fees from AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehrinher-Ingleheim, CardioMatics, Chiesi, Daiichi Sankyo, GPRI Research B.V., Menarini, Novartis, iRhythm, Organon, and The Phoenix Group; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Boston Scientific, Menarini, Novartis, Raisio Group, Wondr Medical, and Zydus; support for attending meetings and/or travel from AstraZeneca; participation on a Data Safety Monitoring Board or Advisory Board for DANBLCOK trial and TARGET CTCA trial; stock or stock options in Cardiomatics; receipt of equipment, materials, drugs leadership, or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid for Deputy Editor: EHJ Quality of Care and Clinical Outcomes, NICE Indicator Advisory Committee and Chair ESC EuroHeart Data Science Group, Commissioned Independent Expert for Cardiovascular Disease for the Impact of COVID-19 Pandemic on Healthcare Systems in the 4 Nations of the UK (Module 3), and Co-Chair of The Lancet Regional Health—Europe Commission on Inequalities and Disparities in Cardiovascular Health. D.D.B. is a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Abiomed, Inc., Amgen, Anthos Therapeutics, ARCA Biopharma, Inc., AstraZeneca, Boehringer Ingelheim, Daiichi-Sankyo, Ionis Pharmaceuticals, Inc., Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Saghmos Therapeutics, Inc., Siemens Healthcare Diagnostics, Inc., Softcell Medical Limited, The Medicines Company, Verve Therapeutics, Inc., and Zora Biosciences; he has received consulting fees from AstraZeneca, Pfizer, Mobility Bio, Inc., and Youngene Therapeutics, honoraria from the Medical Education Speakers Network (MESN), Metabolic Endocrine Education Foundation, and USV Private Limited, and participates on clinical endpoint committees for studies sponsored by Beckman Coulter, Kowa Pharmaceuticals, Novo Nordisk, and Tosoh Biosciences. M.B. declares grants or contracts from AstraZeneca, Boehringer Ingelheim, Canadian Institute of Health Research, GlaxoSmithKline, Sanofi, and Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Canadian Thoracic Society, AstraZeneca, COVIS, GlaxoSmithKline, and Sanofi/Regeneron; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid for Canadian Thoracic Society.

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