Abstract
Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease. A better understanding of mechanisms of cardiovascular risk in chronic obstructive pulmonary disease patients is needed to improve clinical outcomes. We hypothesized that such patients have increased arterial stiffness, wave reflections, and subclinical atherosclerosis compared with controls and that these findings would be independent of smoking status and other confounding factors. A total of 458 patients with a diagnosis of chronic obstructive pulmonary disease and 1657 controls (43% were current or ex-smokers) with no airflow limitation were matched for age, sex, and body mass index. All individuals underwent assessments of carotid-femoral (aortic) pulse wave velocity, augmentation index, and carotid intima-media thickness. The mean age of the cohort was 67±8 years and 58% were men. Patients with chronic obstructive pulmonary disease had increased aortic pulse wave velocity (9.95±2.54 versus 9.27±2.41 m/s; P<0.001), augmentation index (28±10% versus 25±10%; P<0.001), and carotid intima-media thickness (0.83±0.19 versus 0.74±0.14 mm; P<0.001) compared with controls. Chronic obstructive pulmonary disease was associated with increased levels of each vascular biomarker independently of physiological confounders, smoking, and other cardiovascular risk factors. In this large case-controlled study, chronic obstructive pulmonary disease was associated with increased arterial stiffness, wave reflections, and subclinical atherosclerosis, independently of traditional cardiovascular risk factors. These findings suggest that the cardiovascular burden observed in this condition may be mediated through these mechanisms and supports the concept that chronic obstructive pulmonary disease is an independent risk factor for cardiovascular disease.
Highlights
Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease
We hypothesized that patients with chronic obstructive pulmonary disease (COPD) compared with age, sex, and body mass index (BMI)–matched controls have elevated arterial stiffness, increased wave reflections, and increased subclinical atherosclerosis, independently of smoking and other confounding factors
We have shown that surrogate markers of cardiovascular risk are increased in patients with COPD compared with age, sex, and BMI-matched controls, independently of known cardiovascular risk factors, including smoking, and physiological confounders
Summary
Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease. A better understanding of mechanisms of cardiovascular risk in chronic obstructive pulmonary disease patients is needed to improve clinical outcomes We hypothesized that such patients have increased arterial stiffness, wave reflections, and subclinical atherosclerosis compared with controls and that these findings would be independent of smoking status and other confounding factors. We hypothesized that patients with COPD compared with age-, sex-, and body mass index (BMI)–matched controls have elevated arterial stiffness, increased wave reflections, and increased subclinical atherosclerosis, independently of smoking and other confounding factors. We sought to evaluate both the impact of smoking and presence of COPD per se on these vascular biomarkers and the relationship between these vascular biomarkers and COPD severity.[10]
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