The Impact of Cardiovascular and Lung Comorbidities on Patients With Pulmonary Arterial Hypertension

A systematic review published in The Journal of Heart and Lung Transplantation reveals the impact of cardiovascular and lung comorbidities on the clinical characteristics and mortality risk of pulmonary arterial hypertension (PAH) patients, emphasizing the importance of tailored management for this high-risk population.

Contemporary patients with PAH are often older with cardiovascular and/or lung comorbidities and have been traditionally excluded from major drug trials. This systematic review examined baseline characteristics, hemodynamic parameters, and mortality rates in PAH patients with a significant number of comorbidities compared to those with fewer or no comorbidities through a literature search of PubMed, Web of Science, and Cochrane databases.

Seven observational studies included PAH patients, who were older, with a nearly even female-to-male ratio, shorter walk distances, higher levels of N-terminal pro-brain natriuretic peptide, and lower lung diffusion for carbon monoxide. These patients had higher mean right atrial pressure and pulmonary artery wedge pressure, but lower mean pulmonary arterial pressure, pulmonary vascular resistance, and mixed venous oxygen saturation.

Pooled analysis of 6 studies found a higher mortality risk in PAH patients with comorbidities compared to those without, particularly those with lung comorbidities. Patients with comorbidities also received combination drug therapy for PAH less frequently.

“Cardiovascular and lung comorbidities impact the clinical characteristics and outcomes of PAH patients, highlighting the need for optimal phenotyping and tailored management for this high-risk population,” said researchers.

Reference

Gialamas I, Arvanitaki A, Rosenkranz S, et al. The impact of cardiovascular and lung comorbidities in patients with pulmonary arterial hypertension: A systematic review and meta-analysis. J Heart Lung Transplant. 2024;43(9): 1383-1394. doi:10.1016/j.healun.2024.04.066