Chronic obstructive pulmonary disease and metabolic syndrome: traveling with bad companies

López Andreu, F.R.; López Rodríguez, C.

doi:10.1016/j.rceng.2019.07.002

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López Andreu, C. López Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.R." "apellidos" => "López Andreu" "email" => array:1 [ 0 => "frlopezandreu@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." 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The main risk factor is cigarette smoke, but exposure to biomass fuel and atmospheric contamination can be involved in the development of COPD.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Given that COPD only affects approximately 50% of heavy smokers, there must be individual factors that include genetic predisposition, lung development disorders and age.COPD is a serious public health problem that affects up to 10% of the population older than 45 years, exceeding 50% among heavy smokers and is the third leading cause of death worldwide.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In recent years, research efforts have focused mainly on the following aspects: establishing phenotypic groups that enable a more accurate adjustment of the prognosis and treatment; a better understanding of the underlying pathophysiological process and of the factors that perpetuate it, making the disease incurable once it has been established; and changing the natural history of the disease by the presence of various comorbidities and adverse effects of the treatments. Identifying and properly assessing the extrapulmonary manifestations of COPD is also essential.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>American Heart Association/National Heart, Lung and Blood Institute and Consensus Statement defines metabolic syndrome (MS) as the combination of 3 or more of the following risk factors: abdominal obesity, increased triglyceride levels, reduced HDL-cholesterol levels, arterial hypertension and increased fasting blood glucose levels.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> MS entails a notably increased cardiovascular risk, which exceeds the merely additive.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>This issue of Revista Clínica Española presents the study by Sepúlveda et al.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> that assessed the impact of MS in patients with COPD by analyzing various markers related to oxidation processes, as well as pulmonary function tests and symptom severity. The study included 74 patients (39 with COPD) separated into 4 groups: COPD with MS, COPD without MS, controls with MS and controls without MS. The authors measured advanced oxidation protein products, paraoxonase-1, catalase activity, sulfhydryl groups and lipid hydroperoxides. The authors, who mentioned their small sample size as a study limitation, concluded that greater COPD severity (according to the GOLD guidelines<a class="elsevierStyleCrossRef" href="#bib0005">1</a>), greater impairment in pulmonary function tests and the combination with MS were related to increased oxidative stress, indicating as well the presence of increased comorbidity assessed with the Charlson index.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>Due to their anatomical characteristics, the lungs are especially vulnerable to oxidative stress in the environment. The lungs are also permanently exposed to endogenous sources due to mitochondrial respiration and mediators of the inflammatory response against viral and bacterial infections. There are various environmental sources, including tobacco smoke. Once the pathological process of COPD has been established, smoking cessation does not halt the increase in oxidative stress or the disease progression.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Reactive oxygen species of mitochondrial origin, epithelial cells, smooth muscle cells and various inflammatory cells are also involved in this process.A recent study by Fischer et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> emphasized the importance of the balance between oxidants and antioxidants and the role of tobacco in breaking this delicate equilibrium, making it difficult to separate the direct impact of tobacco from that derived from the associated inflammatory response. In a similar sense, the study by Ye et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> concluded that serum modulator-1 levels of reactive oxygen species are high in patients with COPD and are associated with functional impairment, inflammation and oxidative stress. Sanders et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> highlighted the role of the receptor for advanced glycation end products, a cell membrane receptor capable of recognizing ligands generated in tobacco combustion and that has been implicated in the pathogenesis of COPD. Their study demonstrated that deletion or pharmacologic inhibition of the receptor for advanced glycation end products can prevent the development of tobacco-related emphysema.As part of this panoramic approach, we should mention the recent study by Papakonstantinou et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> on the role of hyaluronic acid and its degradation products in the pulmonary pathophysiology and airway remodeling in COPD, which found a direct correlation between serum hyaluronic acid levels and disease severity or the presence of exacerbations.Equally important are the therapeutic implications of this oxidant/antioxidant imbalance because we do not have treatments that can reverse or at least slow the progression of COPD. In contrast to the behavior of the inflammatory component in asthma, the response to inhaled steroids provides a scarce benefit for the inflammatory component of COPD. Oral N-acetyl-cysteine also showed no net benefit on disease progression or the frequency of exacerbations.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In this scenario, directing resources to the effective prevention of the disease and the development of effective drugs to reverse or at least stop the evolutionary process of the disease is essential. It is also essential to further the studies on identifying those markers of oxidative process that could be useful in daily clinical practice as indicators of activity or prognostic factors.Returning to the adverse effects in patients with COPD, both in terms of the rate of oxidative stress and clinical manifestations, attributable to the coexistence of MS (the subject of the study under discussion), the results of the study are supported by a similar study by Díez-Manglano et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> who found diagnostic criteria for MS in up to 60% of patients with severe or highly severe COPD. We can therefore conclude that the concomitant presence of the 2 diseases is, undoubtedly, “traveling in bad company”." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: López Andreu FR, López Rodríguez C. Enfermedad pulmonar obstructiva crónica y síndrome metabólico: viajar en mala compañía. Rev Clin Esp. 2019;219:492–493." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2019 Report. 2019:1-155." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxidative stress in COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.A. Kirkham" 1 => "P.J. 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

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Vol. 219. Issue 9.

Pages 492-493 (December 2019)

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