Carotid intima‐media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study (original) (raw)
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Eurasian Journal of Pulmonology, 2016
Preclinical carotid atherosclerosis, characterized by increased intima-media thickness (IMT), is an indicator of atherosclerosis burden and a CVD risk (4). It reflects the atherosclerotic involvement of the vascular structure, thereby indicating coronary artery disease, cerebrovascular disease, and peripheral arterial disease (5). Carotid atherosclerosis strongly correlates with coronary atherosclerosis (6). The mechanism for the association of COPD with increased carotid wall IMT is not well known (7, 8). It has been postulated that COPD is a disease of accelerated aging (9, 10). Mechanisms related to accelerate aging and cellular senescence are also considered to be involved in the pathogenesis of atherosclerosis (11). Evidence of the accelerated aging process in both COPD and atherosclerosis was confirmed by shortened leukocyte telomere lengths (10, 12), which may provide a mechanistic link between COPD and vascular dysfunction (2). Additionally, low-grade systemic inflammation (8),
Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease
Multidisciplinary Respiratory Medicine, 2013
Background: The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them. Methods: Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intimamedia thickness (IMT) measurements were performed in all the study population. Results: Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV 1 % and FEV 1 /FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02). Conclusions: Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.
Lung India : official organ of Indian Chest Society
Chronic obstructive pulmonary disease (COPD) is an important non-communicable disease worldwide with a rising global incidence. COPD is associated with multiple co-morbidities. Patients with COPD are at increased risk of atherosclerosis and other cardiovascular events. Cardiovascular diseases are an important cause of morbidity and mortality in COPD. The present case-control study was designed to assess the relationship between sub-clinical atherosclerotic vascular diseases with COPD. It was a prospective case-control blinded observational study. There were 142 COPD patients and 124 age-and sex-matched controls without COPD and cardiovascular diseases. Frequency of sub-clinical atherosclerosis was assessed by the carotid B-mode duplex ultrasonography assessment of carotid wall intima medial thickness (IMT). Plaque was defined as IMT of more than 1.2 mm. Prevalence of carotid plaqing was significantly higher amongst patients of COPD (38.7%) compared to controls (13.7%, odds ratio 3.9...
High risk of subclinical atherosclerosis in COPD exacerbator phenotype
Respiratory Medicine, 2018
It is not known whether COPD exacerbations contribute to an increased vascular risk already associated with the disease. For this reason, we prospectively evaluated 127 patients referred for a monographic COPD consultation. We classify as exacerbators those who had experienced two or more moderate exacerbations in the previous year, or who had had a hospital admission. All underwent a blood analysis, respiratory function tests, global cardiovascular and coronary risk estimates (with four of the most frequently used scores, and the Chronic Obstructive Pulmonary Disease Coronaropathy Risk (COPDCoRi) score, respectively); and an EcoDoppler to measure carotid intima-media thickness and the ankle-brachial index. Finally, we included 50 patients with exacerbator phenotypes and 57 with non-exacerbator phenotypes, ranging from 63 ± 7 years old, 74% of whom were male. The exacerbator phenotype increased the risk of carotid intima-media thickness above the 75th percentile range by a factor of almost three, independently of the severity of COPD and global cardiovascular risk. The association between the exacerbator phenotype and high c-IMT was more evident in patients under 65. In conclusion, the presence of subclinical atherosclerosis is independently associated with the exacerbator phenotype, with more pronounced differences in younger patient; which suggests that we should intensify control of vascular risk factors in these groups of patients.
Subclinical Atherosclerosis in COPD Smokers: An Egyptian Randomized Controlled study
Abstract: Background: Chronic Obstructive Pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited. Aim: The present study aimed to evaluate subclinical atherosclerosis in smokers with COPD. Subjects and Methods: This prospective randomized controlled study was carried out on 90 consecutive Egyptians; at Chest and Internal Medicine Departments of Benha University Hospitals, Benha, Egypt. All patients were consented. Study population was randomized into three groups, each comprized 30 patients. Group one included 30 smokers with COPD. Group two included 30 healthy smokers without lung function abnormalities and Group three included 30 healthy volunteers who never smoked before and with normal lung functions(control group). Subjects with diabetes, hyperlipidemia, acute infections, IHD, and respiratory diseases other than COPD were excluded beforehand. Complete medical history, full clinical and radiological examination, complete blood picture, liver function tests, renal function tests, fasting blood sugar, lipid profile, body mass index(BMI), C-reactive protein, ventilatory pulmonary function tests and carotid ultrasonography were done to all subjects enrolled in the study. We determined Carotid intima- media thickness(IMT) and focal atheromatous plaques as an indicator of subclinical atherosclerosis. Results: Our findings demonstrated that mean carotid intima-media thickness was greater in smokers with COPD than normal smokers group and control never smoke group.Also, focal carotid plaques were significantly more prevalent in COPD smokers group than normal smokers and control never smoke groups. Multivariate analysis showed significant association between thickened carotid intima media and decreased percent of predicted FEV1 (P=0.001) and between plaques and Log C- reactive protein levels (P=0.013) independent of patient's age, number of smoked packs/ year, body mass index, peripheral mean arterial blood pressure, heart rate, blood glucose, and low density lipoprotein levels. In conclusion, our observations revealed that, COPD smokers had exaggerated subclinical atherosclerosis. This study suggests that middle aged men who are susceptible to COPD may also, be susceptible to vascular atherosclerosis by smoking, and atherosclerosis changes starts early in the disease process of COPD. Recommendations: We recommend more research studies on larger scale at different ages and in both sexes to understand the mechanism of atherosclerosis in COPD smokers and to identify an optimal treatment.
Open Access Macedonian Journal of Medical Sciences
AIM: To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP). METHODS: We performed a cross-sectional study including 60 patients with COPD (52 male, 8 female), aged 40 to 80 years, initially diagnosed according to the actual criteria. Also, 30 subjects in whom COPD was excluded, matched to COPD patients by sex, age, body mass index and smoking status, served as controls. All study subjects completed questionnaire and underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray), angiological evaluation by Doppler ultrasonography and measurement of serum CRP level. RESULTS: We found a statistically significant difference between the frequency of carotid plaques in COPD patients as compared to their frequency...
QJM : monthly journal of the Association of Physicians, 2016
Cardiovascular disease (CVD) accounts for a significant portion of deaths in patients with COPD, however evidence for early detection strategies for CVD in this population remain limited. Our paper aims to summarize existing data regarding subclinical CVD in patients with COPD with a view to identifying screening strategies in these patients. A systematic review of published literature was conducted for studies examining the relationship of COPD and markers of subclinical disease such as coronary artery calcification (CAC), carotid intima media thickness (cIMT), endothelial dysfunction, arterial stiffness as measured by pulse wave velocity (PWV) and augmentation indices (AIx). Both MEDLINE and EMBASE databases were searched till October 2015. A total of 22 studies were included in the review. Compared with control subjects, patients with COPD had significantly higher cIMT (SMD 0.53, 95% CI 0.16-0.90), PWV (SMD 0.91, 95% CI 0.67-1.16) and AIx (SMD 0.86, 95% CI 0.52-1.19). Additionall...
Egyptian Journal of Bronchology, 2015
Introduction Chronic obstructive pulmonary disease (COPD) is a disease characterized by progressive poorly reversible airway obstruction. COPD is associated with chronic systemic infl ammation, hypercoagulable status, platelet activation, and oxidative stress. These factors may result in subclinical cardiovascular diseases (CVD): for example, carotid atherosclerosis, peripheral arterial diseases, and coronary artery diseases. Aims The aim of this case-control study was the detection of subclinical CVD in COPD patients. Settings and design This was a case-control study. Materials and methods A total of 62 COPD patients and 62 healthy volunteers were enrolled in the present study. All patients were subjected to full medical history and clinical examination, chest radiography, arterial blood gas analysis, laboratory assessment of C-reactive protein, complete blood count, lipid profi le, spirometry, transthoracic echocardiography, carotid Doppler ultrasound, and measurement of ankle-brachial index. A comparison between COPD and control groups regarding different parameters was performed, and a comparison between different stages of COPD regarding different parameters was also performed. Results The carotid intima-media thickness and carotid plaques were signifi cantly higher, whereas the ankle-brachial index was signifi cantly lower in COPD patients compared with the control group, with no differences observed in different stages of COPD. Pulmonary hypertension and right ventricular dilatation were signifi cantly common in COPD patients compared with the control group, and they were signifi cantly increased with progressive stages of COPD. Pulmonary artery systolic pressure and carotid intima-media thickness showed a signifi cant negative correlation with PaO 2 , but showed a signifi cant positive correlation with PaCO 2. Conclusion COPD is a risk factor for subclinical CVD, mainly carotid artery atherosclerosis and peripheral arterial diseases.
Therapeutics and Clinical Risk Management, 2019
Purpose: Chronic Obstructive Pulmonary Disease (COPD) is considered as a risk factor for atherosclerosis and a leading cause of mortality due to cardiovascular disease (CVD). The study assessed the association of COPD with atherosclerotic risk factors and compared the predictor role of various cardiovascular (CV) risk score calculators in Indian subjects with COPD. Patients and methods: Forty subjects with stable COPD and forty age, gender and body mass index (BMI)-matched healthy controls were included in the case-control study conducted in a tertiary care hospital. Atherogenic indices were calculated by using the values of lipid parameters. CV risk calculators were utilized to assess the 10-year CV risk for the COPD group. Results: The study subjects had a mean age of 60.83±12.40 years in COPD group and 57.73 ±9.49 years in control group (p=0.213). Gender distribution was similar in both the groups. The mean High sensitivity C-reactive protein (hs-CRP) levels were 3.70±2.37 mg/L in COPD group and 2.39±2.23 mg/L in control group. The hs-CRP levels were significantly higher in COPD than in control subjects (p=0.012). Using bivariate correlations, we found significant positive correlations between hs-CRP and atherogenesis indices-atherogenic index of plasma, cardiogenic risk ratio, atherogenic coefficient in COPD patients [(r=0.4265, p<0.006); (r=0.7034, p<0.001) and (r=0.7034, p<0.001), respectively]. Framingham risk score-cardiovascular disease (FRS-CVD) has identified maximum number of COPD subjects (45%) to be in high CVD risk category. Conclusion: The study concluded that hs-CRP levels in COPD subjects were significantly higher than in control subjects. FRS-CVD was most useful for identifying high CV risk subjects in COPD subjects.
International Journal of Chronic Obstructive Pulmonary Disease
Background: Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods: This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results: COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion: COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.