In a healthy person, the lungs and the heart work closely together to supply the oxygen your body needs. All the cells in your body need oxygen to work, a process that begins with the transfer of oxygen in the lungs to the blood. The oxygen in the air that comes into the lungs is moved into the bloodstream, which the heart then pushes out to the rest of the body. Both systems need to function adequately for life to be maintained.

But diseases in both the heart and the lungs often go together, and if you have chronic obstructive pulmonary disease, you’re at higher risk of having a heart attack or developing heart disease. Dr. Umur Hatipoglu, director of the COPD Center at the Respiratory Institute at Cleveland Clinic, says that heart and lung diseases “are intimately linked, in fact inextricably so. We evaluate patients to determine whether the problem is from the heart or the lungs and very often, probably more than half of the time, we find that it’s both.”

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According to the Centers for Disease Control and Prevention, more than 735,000 people have heart attacks every year, but not all these individuals have been diagnosed with heart disease. Sudden cardiac death claims about 250,000 lives each year, and a 2015 European Respiratory Journal study linked COPD and SCD, noting that “the risk especially increases in persons with frequent exacerbations 5 years after the diagnosis of COPD.” Exacerbations are complications of COPD that frequently result in hospitalizations.

Similarly, a 2005 Canadian study examined the connection between deaths from cardiovascular disease and COPD, and found that “cardiovascular morbidity and mortality rates where higher in the COPD cohort than in the general population.” In addition, the study found “more hospitalizations for CVD than for COPD itself were reported.” Heart failure was the most frequent cause of hospitalization observed in the study, and their final conclusion states that “CVD is more frequent in COPD patients than in the general population and may represent a burden greater than that of lung disease itself.”

Some of the symptoms of cardiovascular disease and COPD overlap, so it can be challenging to arrive at an accurate diagnosis. Therefore, a 2008 study in the European Journal of Heart Failure noted that “echocardiography and pulmonary function tests should be performed in every [COPD] patient.” Plus, that “greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent [heart failure] and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.”

Because of these associations between heart disease and COPD, Hatipoglu says the presence of “cardiovascular disease modifies the prognosis of COPD patients. In a large study, along with 12 other comorbidities, [such as diabetes and osteoporosis] cardiovascular disease was found to increase the mortality of COPD irrespective of COPD severity. So it was an additional factor.” What’s more, “when you have congestive heart failure and you have COPD, you have two problems in series. Oxygen doesn’t get into the blood, and blood that’s poorly oxygenated doesn’t get pumped through the body. So one disease can amplify the ill effects of the other.”

This close connection between heart disease and COPD shouldn’t come as a huge surprise, Hatipoglu says, “because there are some common threads. Smoking for example, causes both COPD and cardiovascular disease. Physical inactivity and unhealthy diet, both of which generally accompany COPD, can also cause cardiovascular disease. And older people are also more likely to develop COPD, and there’s a higher prevalence of cardiovascular disease in old age,” he explains.

[See: 17 Ways Heart Health Varies in Women and Men.]

Although these factors often coincide, Hatipoglu says the coincidence of heart disease and COPD may go beyond these shared risk factors. “The incidence of cardiac dysfunction is about 20 percent in COPD. One in three patients have coronary artery disease — blockage of the coronary arteries.” But many patients aren’t aware of the heart disease that could be brewing. That’s why it’s important to talk with your doctor about your risk factors for heart disease.

“As clinicians who deal with COPD patients, this is always at the back of our minds. We inquire about risk factors for coronary artery disease. We make sure risk factors and the disease, if present, are managed adequately — management of hypertension, diabetes and of course the common threads of smoking cessation and [addressing] physical inactivity,” he says.

Knowing whether or not you have heart disease in addition to COPD could also potentially alter the way your doctor will treat your illnesses. “We’re finding from observational studies that the use of beta blockers may affect the outcome of patients with COPD,” Hatipoglu says. The Mayo Clinic describes beta blockers as a class of drugs typically prescribed for hypertension (high blood pressure), heart arrhythmias, heart failure and other issues. Beta blockers make the heart beat “more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow.”

The fact that some doctors are now using beta blockers for COPD patients “is really interesting stuff,” Hatipoglu says. “There’s a trial in the United States that’s recruiting right now, investigating the effect of beta blockers on COPD exacerbations.” Hatipoglu says as recently as 10 years ago, using beta blockers to treat COPD would have been controversial: It was long thought that beta blockers would bind to beta-2 receptors in the lungs and cause bronchial constriction, a further narrowing of the airways in the lungs. “Many physicians avoided beta blockers for years because of that,” but “then came selective beta blockers, which exclusively affect the beta-1 receptor in the heart and not the beta-2 receptor in the lungs. So we’re finding now that the beta-1 receptor blockers, the so-called cardioselective beta blockers, may potentially help patients with COPD.” Hatipoglu says this is an active area of investigation that will require further study, but for patients who really need a beta blocker “we no longer hesitate to give them cardioselective beta blockers.”

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Therefore, if you have COPD and a family history of heart disease or are concerned about your risk of heart attack, talk to your doctor about getting tested for various heart issues. There might be a better way for you to manage your symptoms for all of these problems.

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How Are Heart Disease and COPD Connected? originally appeared on usnews.com