Prevalence and Risk Factors of Asymptomatic Peripheral Arterial Disease in Patients with COPD in Taiwan

Ming-Shian Lin,Yi-Jen Chen,Wei Chen,Cheng-Ren Chen,Kun-Yen Hsu,Chuan-Mu Chen,Cordula M Stover

doi:10.1371/journal.pone.0064714

Abstract

AimChronic obstructive pulmonary disease (COPD) is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD) and the associated risk factors for patients with COPD.MethodsThis prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years) without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI) was used to detect PAD (ABI<0.90).ResultsThe overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118) and 10% in the elderly participants (≥65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic PAD (p<0.05). There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second) between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR): 6.89, p<0.005), followed by old age (OR: 4.80), hypertension (OR: 3.39) and smoking burden (pack-years, OR: 1.02).ConclusionsThe prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

Highlights

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, with reported prevalence rates between 5% and 13% [1,2,3]
With regards to cardiovascular risk factors, a significantly higher proportion of the COPD patients with asymptomatic peripheral arterial disease (PAD) had hyperlipidemia (47.1% vs. 10.4%), and hypertension (79.4% vs. 45.8%) than the COPD patients without asymptomatic PAD
To the best of our knowledge, this is the first cross-sectional study to investigate the prevalence of asymptomatic PAD among COPD patients in Asia

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, with reported prevalence rates between 5% and 13% [1,2,3]. By 2030, COPD is expected to represent the third leading cause of death in middle-income countries [4]. Smoking is a major cause of COPD, as smokinginduced inflammation causes vascular endothelial damage via oxidative stress [5]. COPD has been proven to be an independent factor for systemic inflammation [6,7]. Both of these factors can contribute to the development of atherosclerotic processes through a common pathway involving oxidative stress [8,9,10]. COPD is an independent risk factor for cardiovascular morbidity and mortality [11,12,13]

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