2025 GOLD Report on COPD Addresses Cardiovascular Risk in New Section: MeiLan Han, MD, MS, Highlights Rationale

"The idea is that when we treat COPD aggressively, we’re likely achieving broader benefits beyond improving lung function alone."

Cardiovascular disease (CVD) is estimated to account for between one-quarter and and one-third of of mortality among people living with chronic obstructive pulmonary disease (COPD), with the the proportion rising to approximately 40% among those with a CV history.¹ The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report added a new section on CV risk in COPD that highlights the role of disease exacerbations in increasing the risk of CV events as well as the mechanical impact of cardiac hyperinflation on pulmonary vessels, and particularly during exacerbations.²

In a recent interview with Patient Care,® MeiLan K Han, MD, MS, professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI, provided detail on the new section and the rationale for the inclusion in the updated guideline. In the short video segment above, she also commented on the decision to remove a section on vaccination against COVID-19 from the 2025 report and to expand recommendations on recently approved vaccines, eg, against respiratory syncytial virus.

The following transcript of the conversation has been lightly edited for clarity and style.

Patient Care: Addressing comorbidities in people with COPD has become increasingly recognized as essential to improving quality of life and overall outcomes. Do the revised GOLD guidelines address this topic?

MeiLan Han, MD, MS: Yes, there’s a new section on cardiopulmonary risk. The relationship between the heart and lungs has always been significant and always been complex, but now it’s receiving increasing attention. For instance, we know that the lungs’ mechanical proximity to the heart means hyperinflation in the lungs can impair cardiac filling. We also know that inflammation in one organ can trigger events in the other.

An interesting finding we've seen in recent triple inhaled therapy studies is that maximal therapy for COPD doesn’t just reduce pulmonary events, like exacerbations and hospitalizations—it may also lower the risk of certain cardiac events. We’ve known for a while that severe COPD exacerbations are associated with an increased risk of heart attacks and strokes.

So this new section is encouraging clinicians to think more holistically. The idea is that when we treat COPD aggressively, we’re likely achieving broader benefits beyond improving lung function alone.

Patient Care: The section on COPD and COVID-19 has been removed from this edition. However, recommendations for other vaccinations for adults with COPD have been added. Could you discuss these changes?

Han: While COVID-19 remains important, we felt that clinicians have grown more comfortable managing it over the past few years. Initially, there was a need for extensive guidance, but now that the pandemic has become more familiar territory, we shifted our focus to other key vaccinations for adults with COPD.

One of the newer vaccines is for RSV, approved in the U.S. for individuals aged 60 and over. That’s something to consider for our COPD patients. We also want to increase awareness of vaccines beyond the usual suspects like flu, pneumonia, and COVID. For example, shingles, though not traditionally thought of as respiratory-related, can lead to complications like pneumonia.

The goal is to remind clinicians of these additional vaccines and their importance in protecting patients with chronic respiratory conditions.

MeiLan K Han, MD, MS, is professor of internal medicine and chief of the division of pulmonary and critical care medicine at the University of Michigan Health, in Ann Arbor, MI. Han's research focus is on defining phenotypes in COPD using imaging. She is a lead investigator for several NIH sponsored COPD studies and serves as a spokesperson for the American Lung Association and board member of the COPD Foundation. She is currently a deputy editor for the American Journal of Respiratory and Critical Care Medicine and serves as a member of the GOLD scientific committee, responsible for developing the internationally recognized consensus statement on COPD diagnosis and management.