{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T11:53:14Z","timestamp":1772452394309,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Coronary artery disease (CAD) commonly coexists with chronic obstructive pulmonary disease (COPD), but may be under-recognised, since symptoms such as dyspnoea and chest discomfort are often attributed to lung disease. We hypothesised that coronary artery disease is highly prevalent in patients with COPD, even in the absence of typical angina symptoms. Methods: This study aimed to detect CAD in patients with COPD. We conducted a single-centre observational study, including 76 patients with no known previous cardiovascular events. To detect ischaemic heart disease, three methods were used, according to standard clinical indications: coronary angiography, coronary CT, and calcium score analysis on chest CT. The findings were categorised according to lesion severity and vessel involvement. Results: A substantial proportion of patients with COPD harboured previously undiagnosed atherosclerotic coronary disease (78%). However, most detected disease was non-obstructive atherosclerosis (56%), whereas severe stenosis was present in approximately one-third of patients (32%). Single-vessel disease accounted for 37% of cases, while the remaining patients exhibited multi-vessel involvement. Nevertheless, only a small proportion of patients had typical angina symptoms (11.8%), and the most frequent complaint was effort dyspnoea (50%). Patients not receiving inhaled corticosteroid therapy were more likely to have extensive coronary artery disease (\u03c72 (6)= 14.228, p = 0.027). Conclusions: These findings support our hypothesis that atherosclerotic coronary disease is often under-recognised in patients with COPD. ICS-containing therapy appeared to be associated with less extensive coronary artery involvement; however, this observation should be interpreted cautiously.<\/jats:p>","DOI":"10.3390\/jcm15051896","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"1896","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Undiagnosed Coronary Artery Disease in Patients with COPD"],"prefix":"10.3390","volume":"15","author":[{"given":"Zs\u00f3fia","family":"\u00c9reth","sequence":"first","affiliation":[{"name":"Heart Institute, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1rta","family":"Papp","sequence":"additional","affiliation":[{"name":"Hospital of Moh\u00e1cs, Medical School, University of P\u00e9cs, 7700 Moh\u00e1cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8812-7000","authenticated-orcid":false,"given":"R\u00e9ka","family":"Faludi","sequence":"additional","affiliation":[{"name":"Heart Institute, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erzs\u00e9bet","family":"Juh\u00e1sz","sequence":"additional","affiliation":[{"name":"P\u00e9cs Diagnostic Center, 7623 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enik\u0151","family":"Horv\u00e1th","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5911-2774","authenticated-orcid":false,"given":"Attila","family":"K\u00f3nyi","sequence":"additional","affiliation":[{"name":"Heart Institute, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, January 30). The Top 10 Causes of Death. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chen, H., Luo, X., Du, Y., He, C., Lu, Y., Shi, Z., and Zhou, J. (2023). Association between chronic obstructive pulmonary disease and cardiovascular disease in adults aged 40 years and above: Data from NHANES 2013\u20132018. BMC Pulm. Med., 23.","DOI":"10.1186\/s12890-023-02606-1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.2147\/COPD.S410416","article-title":"Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease","volume":"18","author":"Ferreira","year":"2023","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Svendsen, C.D., Kuiper, K.K.J., Ostridge, K., Larsen, T.H., Nielsen, R., Hodneland, V., Nordeide, E., Bakke, P.S., and Eagan, T.M. (2022). Factors associated with coronary heart disease in COPD patients and controls. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0265682"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/clc.20751","article-title":"Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome","volume":"33","author":"Hadi","year":"2010","journal-title":"J. Clin. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1136\/thorax-2023-220615","article-title":"QRISK3 underestimates the risk of cardiovascular events in patients with COPD","volume":"79","author":"Amegadzie","year":"2024","journal-title":"Thorax"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"00492-2020","DOI":"10.1183\/23120541.00492-2020","article-title":"Current symptom-based risk scores for stable coronary artery disease evaluation are not applicable in COPD patients","volume":"6","author":"Beyer","year":"2020","journal-title":"ERJ Open Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/14779072.2024.2333786","article-title":"Cardiovascular disease and risk in COPD: A state of the art review","volume":"22","author":"Polman","year":"2024","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_9","first-page":"679","article-title":"CONSISTE Study Group. Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study)","volume":"7","author":"Moro","year":"2012","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1001\/jama.297.6.611","article-title":"Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: The Reynolds Risk Score","volume":"297","author":"Ridker","year":"2007","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1161\/CIRCULATIONAHA.107.699579","article-title":"General cardiovascular risk profile for use in primary care: The Framingham Heart Study","volume":"117","author":"Vasan","year":"2008","journal-title":"Circulation"},{"key":"ref_12","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2026, January 30). Global Strategy for Prevention, Diagnosis and Management of COPD: 2025 Report. Available online: https:\/\/goldcopd.org\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100357","DOI":"10.1016\/j.opresp.2024.100357","article-title":"Association between coronary calcium detection on chest computed tomography and ischaemic cardiovascular events and mortality in asymptomatic chronic obstructive pulmonary disease patients sysrematic review","volume":"6","year":"2024","journal-title":"Open Respir. Arch."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1136\/thoraxjnl-2012-203151","article-title":"Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality","volume":"69","author":"Williams","year":"2014","journal-title":"Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1055\/s-0035-1556063","article-title":"Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management","volume":"36","author":"Putcha","year":"2015","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"375","DOI":"10.3109\/15412555.2010.510160","article-title":"Mortality in COPD: Causes, risk factors, and prevention","volume":"7","author":"Berry","year":"2010","journal-title":"COPD J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Papaporfyriou, A., Bartziokas, K., Gompelmann, D., Idzko, M., Fouka, E., Zaneli, S., Bakakos, P., Loukides, S., and Papaioannou, A.I. (2023). Cardiovascular disease in COPD: From diagnosis and prevalence to therapy. Life, 13.","DOI":"10.3390\/life13061299"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.cjco.2025.01.001","article-title":"The Intersection of Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: Recent Insights in a Challenging Area","volume":"7","author":"Heffernan","year":"2025","journal-title":"CJC Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1136\/thoraxjnl-2021-218333","article-title":"Cardiovascular disease in chronic obstructive pulmonary disease: A narrative review","volume":"77","author":"Balbirsingh","year":"2022","journal-title":"Thorax"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.ejim.2025.01.016","article-title":"Risk trajectory of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"135","author":"Pirera","year":"2025","journal-title":"Eur. J. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4103\/0970-2113.44427","article-title":"Chronic Obstructive Pulmonary Disease and Peripheral Neuropathy","volume":"23","author":"Gupta","year":"2006","journal-title":"Lung India"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106952","DOI":"10.1016\/j.rmed.2022.106952","article-title":"Peripheral neuropathy: A neglected cause of disability in COPD\u2014A narrative review","volume":"201","author":"Odajiu","year":"2022","journal-title":"Respir. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.2147\/COPD.S159738","article-title":"Evaluation of central and peripheral neuropathy in patients with chronic obstructive pulmonary disease","volume":"13","author":"Aras","year":"2018","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3504","DOI":"10.1093\/eurheartj\/ehaa503","article-title":"An EAPCI expert consensus document on ischaemia with non-obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group","volume":"41","author":"Kunadian","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_26","first-page":"454","article-title":"Coronary microvascular dysfunction: Pathophysiology, diagnosis, and therapeutic strategies across cardiovascular diseases","volume":"24","author":"Scarica","year":"2025","journal-title":"EXCLI J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1093\/cvr\/cvz339","article-title":"Diagnosis of coronary microvascular dysfunction in the clinic","volume":"116","author":"Ong","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e15854","DOI":"10.1111\/echo.15854","article-title":"Clinical impact of multimodality assessment of myocardial viability","volume":"41","author":"Canton","year":"2024","journal-title":"Echocardiography"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Trinkmann, F., Saur, J., Borggrefe, M., and Akin, I. (2019). Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)\u2014Current Considerations for Clinical Practice. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010069"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.21037\/jtd.2020.03.60","article-title":"Management of cardiovascular comorbidities in chronic obstructive pulmonary disease patients","volume":"12","author":"Aisanov","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1586\/17476348.2015.1070099","article-title":"Should We Treat Chronic Obstructive Pulmonary Disease as a Cardiovascular Disease?","volume":"9","author":"Rabinovich","year":"2015","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/S0140-6736(16)30069-1","article-title":"Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): A double-blind randomised controlled trial","volume":"387","author":"Vestbo","year":"2016","journal-title":"Lancet"},{"key":"ref_33","first-page":"PA2482","article-title":"The IMPACT Trial: Single Inhaler Triple Therapy vs dual therapies: Efficacy across multiple COPD endpoints over time","volume":"54","author":"Lipson","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1164\/rccm.202006-2618OC","article-title":"Reduced All-Cause Mortality in the ETHOS Trial of Budesonide\/Glycopyrrolate\/Formoterol for Chronic Obstructive Pulmonary Disease. A Randomized, Double-Blind, Multicenter, Parallel-Group Study","volume":"203","author":"Martinez","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"230084","DOI":"10.1183\/16000617.0084-2023","article-title":"How inhaled corticosteroids target inflammation in COPD","volume":"32","author":"Lea","year":"2023","journal-title":"Eur. Respir. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3390\/ph3030514","article-title":"Inhaled Corticosteroids","volume":"3","author":"Barnes","year":"2010","journal-title":"Pharmaceuticals"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1136\/thoraxjnl-2020-215167","article-title":"Eosinophilic inflammation in COPD: From an inflammatory marker to a treatable trait","volume":"76","author":"David","year":"2021","journal-title":"Thorax"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1896\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:54:26Z","timestamp":1772448866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051896"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051896","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}