For many patients with chronic obstructive pulmonary disease (COPD), the greatest threat to survival may arise not from respiratory failure but from cardiovascular disease. COPD is increasingly recognised as a systemic disease with substantial cardiovascular comorbidity, and in some cohorts, patients are as likely to die from cardiovascular causes as respiratory causes.1 The coexistence of COPD and cardiovascular disease is associated with worse symptoms, increased hospitalisation and greater mortality than either condition alone.2 Cardiovascular risk appears elevated across COPD phenotypes, with patients with emphysema and chronic bronchitis demonstrating approximately two- to threefold greater odds of cardiovascular disease than individuals without COPD.3 Hypertension is particularly prevalent and substantially amplifies cardiovascular risk.4 In hypertensive patients, coexistence of COPD has been associated with more than a ninefold increase in stroke incidence and more than a threefold increase in myocardial infarction incidence.5 Yet despite…
