Determinants of arterial stiffness in COPD

Abstract

BackgroundCardiovascular morbidity and mortality is high in patients with chronic obstructive pulmonary disease (COPD) and arterial stiffness is a potentially modifiable risk factor with added predictive value beyond that obtained from traditional risk factors. Arterial stiffness has been the target of pharmacologic and exercise interventions in patients with COPD, but the effects appear limited to those patients with more significant elevations in arterial stiffness. We aimed to identify predictors of increased arterial stiffness in a cohort with moderate to severe COPD.MethodsAortic pulse wave velocity (aPWV) was measured in subjects with moderate to severe COPD enrolled in a multicenter randomized controlled trial. Subjects were categorized into quartiles based on aPWV values and factors affecting high arterial stiffness were assessed. Multivariate models were created to identify independent predictors of high aPWV, and cardiovascular disease (CVD).Results153 patients were included. Mean age was 63.2 (SD 8.2) years and mean FEV1 was 55.4 (SD 15.2) % predicted. Compared to the quartile with the lowest aPWV, subjects in the highest quartile were older, had higher systolic blood pressure (SBP), were more likely to be current smokers, and had greater burden of thoracic aortic calcification. On multivariate analyses, age (adjusted OR 1.14, 95%CI 1.05 to 1.25, p = 0.003) and SBP (adjusted OR 1.06, 95% CI 1.02 to 1.09, p = 0.001) were independent predictors of elevated aPWV. Body mass index, therapy with cholesterol lowering medications and coronary calcification were independent predictors of CVD.ConclusionsElevated arterial stiffness in patients with COPD can be predicted using age, blood pressure and thoracic aortic calcification. This will help identify subjects for enrollment in clinical trials using aPWV for assessing the impact of COPD therapies on CV outcomes.Trial registrationClinicaltrials.gov NCT00857766

Association between Airflow Limitation Severity and Arterial Stiffness as Determined by the Brachial-Ankle Pulse Wave Velocity: A Cross-Sectional Study

“…Mills et al demonstrated that the patients with COPD had increased arterial stiffness compared with ageand smoking-matched controls (21). Bhatt et al demonstrated that the aortic PWV values may be an important predictor of CVD for the patients with COPD (22). In a review by Maclay et al (23) of men without cardiovascular disease, a relationship between reduced pulmonary function and increased PWV was found, independent of the traditional risk factors for cardiovascular disease, such as smoking, hypercholesterolemia, and hypertension (24).…”

Tensiometric and Phase Domain Behavior of Lung Surfactant on Mucus-like Viscoelastic Hydrogels

“…The composition of CAS is closely represented by pulmonary surfactant generated from Type II cells in the alveoli 22–23 . From the alveolar spaces, pulmonary surfactant is carried up the airways due to the surface tension gradient and the mucociliary escalator 22, 24 .…”

“…Local production and release of phospholipids by tracheal epithelial cells 25–26 and the submucosal glands of both human tracheal and bronchial biopsy specimens 27 have also been detected, thus both sources likely contribute to airway surfactant composition. While evidence pertaining to the origin of the CAS points to both alveolar and local sources 12, 28 , recent studies suggest that alveolar surfactant represents the largest proportion of CAS 22–23 . CAS phospholipids, quantified by analysis of raw tracheal aspirates, are composed of approximately 72–80% phosphatidylcholine (PC) and 33–45% dipalmitoylphosphatidylcholine (DPPC), with smaller amounts of phosphatidylglycerol (PG, 3–4%), phosphatidylethanolamine (PE, 12–15%), phosphatidylinositol (PI, 3–5%), and sphingomyelin (SPH, 2–4%) present 22–23 .…”

Contribution of chronic obstructive pulmonary disease to remodeling of target organs in patients with arterial hypertension and ischemic heart disease associated with chronic heart failure

“…По данным A. C. Aykan и соавт., у больных ХОБЛ сердечнолодыжечнососуди стый индекс, отражающий истинную жесткость арте рий, не зависящую от АД, был значительно увеличен и коррелировал с ОФВ 1 , индексом Тиффно и стадией ХОБЛ [15]. В мультицентровом рандомизированном исследовании, как было представлено в публикации S. P. Bhatt и соавт., у больных ХОБЛ СПВ в аорте была взаимосвязана не только с возрастом, уровнем САД, статусом курения, индексом кальцификации аорты, но и с ОФВ 1 по данным спирометрии [16].…”