Pulmonary hypertension and chronic obstructive pulmonary disease in sickle cell diseases

Abstract

Background: Pulmonary hypertension (PHT) is a common consequence of chronic obstructive pulmonary disease (COPD). Methods: All patients with sickle cell diseases (SCD) were included. Results: The study included 434 patients (212 females) with similar mean ages in males and females (30.8 versus 30.3 years, p>0.05, respectively). Smoking (23.8% versus 6.1%, p<0.001), alcohol (4.9% versus 0.4%, p<0.001), disseminated teeth losses (<20 teeth present) (5.4% versus 1.4%, p<0.001), ileus (7.2% versus 1.4%, p<0.001), cirrhosis (8.1% versus 1.8%, p<0.001), leg ulcers (19.8% versus 7.0%, p<0.001), digital clubbing (14.8% versus 6.6%, p<0.001), coronary heart disease (CHD) (18.0% versus 13.2%, p<0.05), chronic renal disease (CRD) (9.9% versus 6.1%, p<0.05), stroke (12.1% versus 7.5%, p<0.05), and COPD (25.2% versus 7.0%, p<0.001) were higher but not PHT (12.6% versus 11.7, p>0.05) and deep venous thrombosis (DVT) and/or varices and/or telangiectasias (9.0% versus 6.6%, p>0.05) in males. Conclusion: SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level since the capillary system is the main distributor of hardened red blood cells (RBC) into tissues. Although smoking, alcohol, disseminated teeth losses, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, stroke, and COPD-like atherosclerotic events were higher in males, PHT and DVT and/or varices and/or telangiectasias were similar in both genders. Similarly, although the male gender alone is a risk factor for the systemic atherosclerosis, the similar prevalence of PHT in both genders also supports its nonatherosclerotic nature. In another definition, COPD may have an atherosclerotic whereas PHT a hardened RBC-induced chronic thromboembolic background in the SCD. Key words: Sickle cell diseases, pulmonary hypertension, chronic obstructive pulmonary disease, endothelial damage, atherosclerosis, metabolic syndrome, aging